WE HAVE NO BEDS

The Alternative Residents

Handbook

Dr. Dick Dartos

 TABLE OF CONTENTS
SECTION 1: CUSTODIAN
VIRGINATIS........................................5
STOPPING THEM GETTING IN........5
(I) THE HONEST APPROACH.......................5
(ii) THE RUDE APPROACH...........................7
(iii) THE UNDERSTANDING APPROACH.....9
(iv) THE BULLSHIT APPROACH................10
SECTION 2: THRUSTOPELVES.....12
WHAT TO DO ONCE THEY’RE IN.. 12
(I) RECOGNITION........................................12
(ii) PASSIVE EVASION................................14
(iii) ACTIVE EVASION................................15
(iv) HYPERACTIVE EVASION.....................17
SECTION 3: PARTURITION............19
GETTING THEM OUT......................19
(I) PRIVATE EXCRETION............................19
(ii) PUBLIC EXCRETION............................21
(iii) ABSOLUTE CONSTIPATION................22
SECTION 4: YOUR FIRST DAY......23
(I) YOUR FIRST DAY IN THE E.D................23
(ii) YOUR FIRST DAY IN SURGERY...........24
(iii) YOUR FIRST DAY IN MEDICINE..........27
SECTION 5: HANDLING SPECIFIC
PRODUCTS......................................32
(I) CHEST PAIN............................................32
(ii) FRACTURED NECK OF FEMUR...........33
(III) BACK PAIN............................................34
1
(iv) CVA/TIA.................................................35
(v) SIGNIFICANT FRACTURES – ..............36
(vi) P.V. BLEEDING......................................37
(vii) CCF.......................................................38
(viii) OVERDOSES.......................................38
(ix) DISLOCATIONS....................................40
(x) COLLAPSE.............................................41
(XI) PNEUMONIA/ASTHMA.........................41
(xii) LOONIES ............................................41
(XIII) FOREIGN BODIES..............................41
SECTION 6: THE PEOPLE AROUND
YOU..................................................42
(I) NURSING STAFF....................................42
(ii) RELATIVES............................................43
(iii) INTERNS...............................................45
(iv) MEDICAL STUDENTS...........................45
(v) AMBULANCE DRIVERS........................45
(vi) RADIOGRAPHERS...............................45
(v) CONSULTANTS......................................46
(vi) HOSPITAL UNION REPRESENTATIVES
.....................................................................47
(vii) ADMINISTRATORS..............................48
SECTION 7: GLOSSARY OF TERMS
..........................................................49
WHAT DOES IT MEAN?..............................49
 Introduction
There are many simple aspects of public
hospital medicine that are only learnt by
experience and become invaluable. They are
sometimes taught but more often, they just
seem to happen over time. For too long now,
perhaps this most important part of any
resident’s training has been ignored. Medical
students have been instructed in basic
sciences at university. Similarly, medical and
surgical teaching was completed in the public
hospital system. Following are, internship,
residency and, perhaps, consultancy, with
training in the traditional accepted manner. But
all this only indirectly teaches us the true art of
public medicine. Any resident who has been
around for a while has a certain sixth sense, of
which he/she may or may not be aware.
(Unlike the movie, they say ‘I don’t see dead
people – in fact, I don’t see many people!’) It is
a very difficult thing to explain. Some never
get it; all ‘proper’ registrars exude it. They
shun unnecessary information, patients and
thereby, work. They retain only what is needed
and useful, and apply it in ways that
spellbound the tyro. I remember often
watching my registrar in awe, and soon learnt
to note down his quiet advice. This skill is
there when one look diagnoses a patient; or
when one astute phone call has their
placement worked out before the patient is
seen.
A registrar worrying about a patient. (‘How
can I piss off this dunny?)
That sort of thing. It is coming to you when you
start to recognise unforgiving classes of
patients as they walk through the door, and
yet, you are not concerned as once you were.
You become intimately aware of the
possibilities that arise in such a situation.
Sometimes. Even the true believers may see a
dunny and sit, fume and swear. Do not fear.
The registrar has not lost his powers – he
knows that in some cases the vege is his, no
matter what he does. In these situations, they
soon accept this and go straight to sorting
them out – and where else they can be sent
most quickly. Hence a good registrar shuns
2
what is not his, yet quickly accepts what is.
For example, an Orthopaedic registrar
wandering through Emergency will quickly see
a fractured femur, but the back pain can stay
the ED resident’s private patient. The registrar
remains cool in a crisis that is never of his own
making.
ED
The area of the hospital where this talent is
(truly) beautiful, expandable, nay vital, is the
Emergency Department. (ED). Good work, (or
absence of it) in the E.D. is of benefit to all
within the hospital, and the Admitting Officer
with his feet up and nothing to do is the
hospital’s symbol of success - par excellence!
You learn most techniques in the ED, so it is
here I will concentrate - but it applies
throughout the hospital.
You learn many techniques
The other rotations will be explained also. In
most cases, because the AO is the king, I refer
to him/her in most chapters – but the lessons
are there to be used in any of your rotations.
The basics
I will attempt to provide a guide to the
basics of survival in the hospital. This involves
some medical knowledge (though nothing like
what you have been taught before), technical
skills (often used), organisation and
appropriate interaction. But by far the most
useful tools are common sense and
determination. And add a little fire in the belly.
You know the heights have been obtained
when a nurse says: ‘Now he’s a good
resident’.
This is a guide for existing and potential
residents, explaining the practicalities, the
skills, the previously unrecorded flashes of
brilliance, pertaining to this far too complex
job. I will show you how this complexity is
reduced. But I can see you nodding walls all
smug and knowing; of course, you have much,
 Introduction
much more. I only offer a guide – those
learning the skills also need a good
imagination. By referring to this compilation, it
will soon be easy for any tyro to avoid, evade,
treat, (only when absolutely necessary and
with no compromise of the patient’s treatment)
and refer, the ubiquitous, the hated, the tragic
- ‘Dunny.’ And all with an absolute minimum of
exertion. I will teach you how to perform these
tasks in increasing levels of said exertion, so
that the product is handled in recurrent,
habitual fashion, automatically and efficiently.
This will happen of course, in the best
interests of the patient. (See later - The
bullshit approach.) And all with a sort of
glossobuccal insertion.
This Is NOT a dunny
HOG
Please refer to the glossary for the meaning of
certain terms in the text. All are used in the
E.D., some are House of God, but either way,
flip to the back when confronted by a new
term.
Yes I have also been influenced by the HOG –
it should be read as soon as possible by all
students and residents. But it is too American
for practical use. Our basic processes involve
some buffing and turfing, but more often, it is
Avoidance, Evasion and Excretion. Through
these three processes the decision is made as
to who gets to see you, who stays with you,
and who gets turfed. I include all patients, but
most are segregated out in the process,
leaving only the dunnies - and it is to these I
actually refer. Hopefully, you won’t
misdiagnose a real patient as a dunny – but
that’s your problem. (See later, Administration;
‘Deny All Knowledge’
Sections I to 3
The guide is divided up into sections. Section
1 outlines the basic avenues of attack. Firstly,
what can we do to not even let the dunny
enter the ED? This involves the theory of
Custodian Virginatis, - yes, it is in Gray’s
3
Anatomy (Gracilis is its other name) - itself
divided up into the four basic approaches:
Honesty, Rudeness, Understanding and
Bullshit.
Section 2 then goes on to further explain how
not to see them if they subsequently do arrive.
This is the Thrustopelves - what to do once
they’re in. Here we look at actual Dunny
Recognition and Evasion, at all three levels.
(Passive, Active and Hyperactive.)
And finally, in Section 3, if you must see them,
how to quickly get rid of them. I.e. Parturition.
Removal through Private Excretion, Public
Excretion, and dealing with Absolute
Constipation - the heart breakers.
This is more like a dunny
These notes ignore the actually crook patient,
those obviously non-negotiable. As I said, we
refer to your Dunny Classique; i.e. ‘. an
untreatable vegetable which actually doesn’t
require treatment, and certainly not hospital
admission....’(See index.) Absorb from within
that previous quote the basis of the theory of
Dolt Management.
Representation of Dunny Classique
Section 4
That amazing first day in the hospital.
Terrifying. Nothing else, just terrifying. Will you
do your career on day 1? Odds are you won’t
 Introduction

– you’ll just feel incompetent, dangerous and Non-dunnies

useless. Sorry. The stress cannot be lessened
I do not include all patients as dunnies. The
– until now. I will attempt to guide you through
sickies are segregated out in the process.
this day on the major rotations – Emergency,
Treatment of the ill is covered elsewhere. And
Medicine or Surgery.
one of the most vital skills is recognising the
crook patient. Hints are given on this in the
Section 5 situations where crook patients may be
In Section 5 we go on to specific cases, missed – AMI, paediatrics, some fractures etc.
outlining the basics of how to get different But the crook make up very little of your day –
types of products down the production line, guess what does? This is obviously not a
with very little physical or mental exertion. This textbook. (Another skill there: ‘Never forget the
is your guide to the Minimization Routine. It lawyers’).
provides a vague summary of what to listen
for, what to look for, what to test for, and what The Author
to hit for four. The suggestions are a guide
The author has a long, though dubious,
only and protocols provide better detail, but
history of Emergency involvement - many say
when you’re good, who needs ‘em? When
too long - and looking at things from
you’re bad, tape them to your forehead.
experience in jobs from most positions.
(Disagree with my suggestions? This is only a
There’s different ways of doing things - watch
guide, so if you want teaching, go read a
others around you, and put yourself number
wanky journal!)
one.
If you consider this the work of a medical
Section 6 heretic.......you’re working too bloody hard!
Section 6 is perhaps the most difficult to
absorb. Hmmm...no, not perhaps. It is. Section
6 is concerned with coping with the people you
will associate with in the hospital. Most are
there to obstruct you. (It is especially heart
breaking for interns when they realise that
even their senior colleagues undermine them
for their own gain. Sad but true, but they can
get back at next year’s ‘terns!)

Section 7
The glossary – all the terms you should
know – and some you shouldn’t
The author after 15 years in the ED
The Resident’s life
The resident’s life is a bloody difficult one, with
long hours, a distracting and annoying pecking Lawyer’s Note:
order, all for very little reward. It is not obscene Dr. Dave Dartos was deregistered in
to reduce one’s workload in a way, which 1987 and has worked for 15 years in
makes very little difference to the patient - they ED as a cleaner.
might even be better off. What you end up
learning from the guide is how to adequately
treat patients but doing as little work as
possible. This is vital in an atmosphere of such
mental torture, that many residents work with
the equivalence of moderately significant
Blood Alcohol Concentrations running through
their heads. With a little time, and help from
older, true AO’s, the skills become automatic.
Numbers seen are kept to a minimum, and
those vegies which must be seen are sorted
quickly. You are beyond the fake
understanding. You must compromise at your
acceptance - you both smile and frown.

4
 SECTION 1: CUSTODIAN VIRGINATIS
Stopping Them Getting In.

Vital ability one of your dreaded dunnies, Doctor.....’)

Even so, you should not limit your talents to
Avoiding even seeing the dunny is
more pleasurable areas such as blissfully
probably the most vital ability of any good
brave bullshit - be prepared to learn the
AO or resident. If you can stop the buggers
principles of Dunny Avoidance via the
even darkening your doorstep, you’re
honest approach. Sure, it’s not often
already a real winner. The elation
successful, but then neither is preventative
experienced following a first-rate slag off is
medicine, weight loss advice, CPR, taking a
something akin to post-coital bliss, and is
history, Category 5 patients’ synapse
often better. In order to obtain this state
transmission, a nursing co-ordinators’
known as AO Nirvana, one must assume
charm classes, the answering of a phone,
one of the four basic positions. Together
obscure diagnosis success, an intern’s
they form the philosophy of Dunny
plaster, cynicism avoidance or
Avoidance. They should only be attempted
‘counselling’; .......(sorry, distracted
with great care by the inexperienced, as
again).....but we seem to persist with those!
they have at times resulted in severe
personal and professional injury. Once ‘the
state’ has been attained, any of the four
positions can be called upon at any time, in
any sequence, for advancement of that AO
or resident. They are:
The Honest Approach - ‘Honesty is the
worst policy’.
The Rude Approach - Satisfying until the
shit hits the fan.
The Understanding Approach - this
quickly loses its charm.
The Bullshit Approach - creativeness is
its own reward.
So, here is the situation. Some Try honesty. E.g. ‘The airport is handy’
misguided patient, relative, GP, consultant,
fellow resident - whoever has rung, No beds
suggesting there is someone who needs
Yes it’s the age-old line - you simply
your care, so would you ‘have a look at
have no beds. It has lost its charm a little
them’. (i.e. ‘I am fed up with this dunny’).
now, as it is virtually always true. Bullshit
First exclude obvious serious pathology.
has become honesty, a very sad situation.
Okay, they sound like a dunny. Now: Slight
Be a little more expansive though. Tell the
pause. Keep a cool head.
Gomer Producer to ring back the next day
Accept nothing as being true.
to check the bed status then, as some beds
Raise your respect to only the minimal
may have become available after ward
level needed, and then, move your mind to
rounds. Entirely true. But you fail to point
the appropriate approach.........
out that you will not be on, and a less
bright, perhaps more understanding, AO
(I) THE HONEST APPROACH may accept the patient - thus avoiding the
bounce as well. Be very careful that you
To be or not to be? don’t find the GP ringing back on your next
Honesty is not a particularly desirable shift; slagging off patients to yourself is
quality in the make-up of a really shit-hot frustrating and pointless. Sieves are there
AO. It tends to pack the ED with patients, or to be used. If you do mistakenly do this,
your record with complaints. (e.g. break the cycle early. Tell the Local Moron
‘goodness, we have plenty of beds at the Overseer that all things considered, he/she
moment, but that sounds a bit like another may have more success after hours, when
few alternatives are available for slagging

5
of a vege. Honest, yes - but beware of
upsetting another good AO - a battle
between two such Walls is ugly and all
consuming. If no sieves are available, look
to another approach. Rosters should
always be handy. And that should have
been in italics - I just feel a little guilty;
whatever that means.
Zones
All hospitals have basic zoning policies,
which are now coming more and more into
use. This is because most people are
aware of the most appropriate public
hospital for them. But they may be silly, or
the zones not be enforced. So if a patient is
on the way from some GP seemingly much
closer to another ED, be honest - they are
not in your zone. Advise them of the
nearest ED to which they should attend,
explaining that you will probably just
transfer them there anyway. Always be
ready with the name and phone number of
the other ED - ‘I don’t know,’ or even just
hesitation can prove costly. Zones are
expanded upon in Bullshit, as you can
probably guess!
Insurance status
One strong weapon, amazingly so often
ignored by GP’s, residents and sometimes
even registrars, is whether the patient is
HBA +ve or -ve. Always try and ascertain
this over the phone. It may suddenly
register with the GP and he’ll admit them
directly under himself/consultant, or even
better, to a private hospital. Honestly,
everyone is better off - dollars for the
doctors and hospitals, use of expensive
insurance by the patient in a much nicer
place, and no dunny for you and the
accepting registrars. You may have to
sound as though this is the usual and
obvious course of action, and this can be
done without Rudeness or Bullshit. (But
these may be necessary!)
Institutions
The patient may sound obviously
inappropriate for an ED, and can be
sloughed off directly to an institution. For
example, one may give advice that a
Loony or Gerry could go straight to the
Bin or Nursing Home - their natural areas
of repose. In such a case, you need to put
in a bit of effort getting a very clear picture
of the dunny and its overall situation. Get a
good idea of the vege-level involved -
6
always spend quality time with the referring
person. Advising a direct transfer can avoid
a lot of work for a lot of people.
Some dunnies go directly to the bin
And...ummmm.....is in the patient’s best
interests. An example might be a
depressed person the GP wants to send in,
but on questioning, the patient may agree
to go straight to the bin as a voluntary
patient. Calling the CAT team is a neat aid.
GP’s, especially Locums may not be
familiar with system, or be very busy
struggling to make ends meet and forget.
One less patient of this variety seems a
small request to make, as all public
hospitals are already full of loonies and
gerries - and that’s just the staff!
Uninterested
In all honesty, advise the Gomer
Producer that you are simply not interested
in such a patient. Apologise and say
goodbye. Blandly, authoritatively and
without rudeness or hesitation.
This is an indication that your shift has
just ended. Sadly, of course, you are
usually just sent the patient - but there are
times when you have a very confused
person holding a telephone in their hands,
the engaged tone ringing in their ears, and
a seed of doubt in their minds as to whether
it’s worth proceeding with the Toilet
Transplant. If they ring back, tell them you
just fell asleep on the phone.
You should never answer a phone unless
you have to. Bad things can only happen if
it’s not you originating the call.
This is probably an indication that your
shift has been too long and is about to
finish. Any temporary delay will let the new
AO sort it out. We must all allow for slag-
offs at the end of somebody else’s bad
shift. We all do it.
NEVER answer this machine – it only
means work
Spanners
Always consider chucking in the odd
spanner. A spanner would be advising a
relative of the presence in your hospital of a
patient with HIV; the vague suggestion
implanted in their minds being that granny
could catch it through a shared teacup. Or
whatever is the current scare. Spanners
mean nothing to anyone with half a brain,
but just may keep the dickhead from your
door - and after all, isn’t that what it’s all
about? Other spanners: Tasmanians,
Golden Staph, Garibaldi’s, ex-convicts,
communists, Iranians/Iraqis, men with hairy
ears, UFO’s, - Urinating Farting Oldies -
and admitted members of staff. (AGHHH!)
Bans
Far more often than you care to
remember, the Dolt being presented over
the phone is very well known to yourself -
you know the type; this Dunny comes in
once a week for the same old non-medical,
non-human condition. Point out, in all
honesty, that the patient cannot be seen, as
they have been indefinitely banned from the
department. You are not sure what it is that
they have done, but the writing on the
history; (which you have had sent up from
medical records while you make the GP
wait on the phone - he may give up....) is
plain as day - Not to be seen in ED again.
Also plain as day, if needed, are your
writing and the wet ink.
Emergencies only
Any reasonable person would accept
the fact that Emergency Department means
just that. The new emphasis is widely
known now, and there is no place in the ED
for trivial cases such as coughs, colds,
sprains......ummm.......chest pain, fractures,
renal failure, arrests,..... Shit, sorry, didn’t
7
mean to trivialise there. Sorry..... Not.
End of shift.
The Worst Policy
As mentioned previously, taken overall,
the honest approach has somewhat limited
success. The reasons for this are obvious -
dunnies pounce on the truthful, and truth
has little place in modern society. The
scrupulously honest don’t last long.
And remember that GP was once one of
us, and can recognise a scam. The
younger ones were just recently registrars,
if you can believe it. They are known as
‘fallen angels’ – avoid them at all costs.
They use their powers for evil.
Be wary of registrars who suddenly
appear as GP’s
And so, more often than not, your best
intentions have led nowhere. One then
needs to proceed to another approach.
Lose sensitivity and gain some fire. Let us
consider something a little more fruitful -
Rudeness.
(ii) THE RUDE APPROACH
A Niche
Rudeness, unfortunately, has a rather
limited application for the AO, due to a wide
variety of complications which arise from its
use - there is certainly no doubt about it’s
effectiveness. Ergo, a niche it does have.
There are some that would say that
nastiness is right up there with the
cherished art of bullshit in an AO’s
armament. I tend not to place it quite that
high, but it comes into its own (yuck!) when
other approaches are failing and the
situation is looking desperate. That is, when
there is nothing left to lose. Nursing staff
may get particularly distressed during its
use - it makes everyone look a bit
unprofessional - but in the correct
circumstances, they will applaud its use. to such a bastard as you! Getting berated is
Such circumstances include a pleasant AO annoying but gets you out of the
who has reached the end of his/her tether department for a while.
with patients or relatives who have treated
you like some sort of moronic public
servant, there just to confirm what someone
else (including themselves) has diagnosed.
They may have similarly treated the nurses
poorly. Suddenly, Rudeness becomes
acceptable.
These dunnies and their relatives are highly
trained morons so give their skills the
response they deserve.

Just refuse
The baseline in rudeness techniques,
when you’ve got a definite Local Moron
Overproducers on the phone who wants to
Producer of eye balsam for certain Local
send you a Friday afternoon special, is to
Moron Overseers
flatly refuse.
Lawsuits excepted, suspension is a holiday.

Feel the hate

Friday Afternoon Special awaits
ambulance
You’ve tried all your previous techniques
and charms, but this guy just isn’t listening.
Firmly point out that you are most
unimpressed with his previous examples of
‘emergencies’, and this just sounds like
another, much the same. Indeed, go on to
outline his personal habits which you find
quite offensive, and that the rumours about
him, as far as you are concerned, are
absolutely true. Tell him he should be a
market gardener with all the vegetables he
produces, and that the phone call should be
immediately terminated. (Do NOT use this
with Fallen Angels).
For example: ‘Bugger you, you stick-
whacking paedophile, I’m not accepting any
more of your rubbish. Please go and stick
your left eye in hot cocky shit. Goodbye.’
(Note - example only – skill, care,
experience and timing are necessary or
harm may result.).
Now await the inevitable phone call from
the boss; it never fails. But at least it’s
highly unlikely that the patient will be sent
Have you ever walked into a shop, and
the sales assistant has obviously had a bad
day. They are really shitty, and I can
understand that. So why the hell should we
be any different? We work harder than
those bastards, for (overall) less money per
hour. So, get nasty. Remember the Hospital
Volunteer Ladies Guild motto: ‘You’ve gotta
feel the hate!’ Don’t even listen to anyone’s
story - just tell them you’ve had a gutful,
you’re bloody tired, and anyway, you didn’t
want to do medicine in the first place. Then
hang up. This never works, but it’s really
good fun. Surprisingly, there are rarely
repercussions from this one, as this
appears to completely confuse the other
person; or perhaps it strikes some
sympathetic cord in them? Perhaps it is
change of hospital time. If it is that time,
then use these opportunities.
Relative Rudeness
One golden rule, if you are going to take
the rude approach, is always be rude to
relatives over the phone.
This has a number of advantages. If
they like granny, there’s no way they’d want
you looking after her.
(Never give your name when answering
this type of phone -call) - just say
‘Emergency’, until you find out what is
going on.)
If they don’t particularly give a stuff
about granny, you would have copped her
anyway - so what have you lost? There is a

8
problem with regard to complaints to
Medical Admin, but hell! Don’t let that stop
you! Just deny all knowledge. Say you don’t
know who these people could possibly
have been talking to.
Either way, you most likely didn’t have to
see the dunny; and if they weren’t a dunny,
and were genuinely unwell, you probably
would have seen them no matter what you
did or said. Anyone who honestly believes
they have a sick person on their hands
doesn’t fart-ass around on the telephone.
Ergo: waffling on the phone means ‘dunny’.
Dementia
If all else fails, suggest that the patient,
it’s relatives and the GP were so sadly
demented if they thought they could get
past you, that they could probably get a
group discount at a private psych hospital.
It’s just all so bloody hard, really.
(iii) THE UNDERSTANDING
APPROACH
Caring
The role of the medical practitioner is
often seen by people as that of a caring,
sensitive, understanding professional. Oh
yeh. If they’re silly enough to believe that
this is true, at all times, take advantage of
it! Present the case for the dunny not
coming in to the Emergency department in
such a way that they simply can’t go
against the wishes of such a kind, caring
and sympathetic doctor such as yourself. A
doctor who has nothing but the patient’s
welfare at heart. Exude a warmth which
brings tears to the eyes of the staff around
you, who are staring in admiration as you
express your compassionate views on the
situation.
How medical students see patients
Hell, it was a complete surprise to me that
this touchy-feely crap that all medical
students seem to be taught now actually
works sometimes! (I once asked a student
9
about the ureter; he told me he doesn’t
know anything about that, but he knows all
about comforting a patient after a renal
transplant! ARRRRRRGH!)
Own GP
Has the patient been to see his own
doctor? If not, explain the advantages of
being seen by a doctor who knows the
patient so well. Hell though, you’d really
love to meet gramps, but you know this is
just thinking of yourself - he’s in better
hands with his own doctor. Mind you, he
sounds like such a wonderful old coot
whom you’d just love to cure. (In this
situation, always give your full name, as it
may lead to good reports to medical admin,
or even monetary gifts.)
No beds revisited
Though seemingly repetitive, tell them
there’s no beds - but with a twist. The
difference is that because you are vitally
interested in the welfare of all patients, you
want to make sure that they get a bed
somewhere. (You don’t want them on your
doorstep, so you have to give them
something concrete to stay off your back.)
Suggest alternative hospitals.
Registrars
There are many other things you can
suggest. Would the GP like to speak to the
appropriate registrar about the case? Now,
two things can happen following this
suggestion. Firstly, the patient is a real
dunny. No self-respecting GP could discuss
such a patient with a registrar. You’ll just get
it. Secondly, the GP may feel that he can
handle the registrar, and will discuss it with
him/her.
Please
turf me, I am
a vege
How registrars see patients
This is wonderful, as registrars are shit-
hot at slagging off patients. So it is
therefore worthwhile to have to have some
registrar annoyed with you for sicking GP’s
onto him/her, when you have excreted by
proxy.
Beware of registrars you have sloughed
to
The registrar will quickly get over it -
especially when you highlight all the other
rubbish you have slagged off for him/her
which a lesser AO would have had them
seeing. To top things off, the GP thinks
you’re a great guy, and not the prick you
really are! (A word of warning though - don’t
use this trick too often with the same GP or
you’ll have the bastard on the phone to you
all day offering all sorts of nonsense.
Indisperse a touch of rudeness.)
Outpatients or Rooms
Another offering from an understanding
Admitting Officer is that of Outpatients,
(dwindling these days) or consultant’s
rooms. Be aware of all local possibilities.
In fact you’re so nice, you’ll organise the
appointment for them. You make the
appointment as otherwise it may not
happen and you could still inherit the
customer. Why not try a nursing home? It
may not happen that day but you can at
least get the ball rolling – it might be
enough to satisfy a person on the phone.
Arseholes
The above suggestions are always
handy later on if some bastard says that
you were a real prick to medical admin - in
other words, they work you out - you can
honestly point out at your next censuring
meeting, that you went out of your way to
provide alternative avenues for the patient
or GP to pursue. It’s not your fault the idiots
can’t follow simple advice. (Use different
words at the censure).
Good old HBA
Surely poor old gran wouldn’t want to
come in to a yucky old public hospital,
10
would she? After paying those thieving
bastards at HBA all her pension money for
years while her cat starved? Payments
made so she could stay in a plush private
hospital. ALWAYS ask sensitively about the
existence of insurance.
Don’t forget about MAB, Veteran Affairs,
Workcare, sickness/injury insurance, cover
by employer, covered by parents, etc. etc.
All that matters is: what is best for them is
normally best for you.
(iv) THE BULLSHIT APPROACH
‘Beautiful Bullshit’
This is my favourite. This is where you
really get to show what sort of imagination
you have. Forget your principles
completely. Empty your mind of useless
concepts such as truthfulness, morality or
righteousness. Get into the habit of letting
the bullshit flow. Tell blatant lies. Cold hard
calculating lies. Lies with flair intermingled
with blunt untruths. Confabulations that only
a true artist could lay claim to. Flagrant
bullshit explained in such detail, and in
such a matter of fact way, that even the
most doubting Thomas is fully convinced of
their truth. The fools are there to be fooled.
And never be indecisive while bullshitting.
Even when you are obviously completely
out of touch with reality. Someone will
believe it.
Zones again
Let’s take hospital zones again, but in a
different light. As mentioned previously,
there is someone on the line who thinks
they are sending you, the wall of bullshit, a
dunny.
‘Sorry, where did you say you were from?
No - you’re not in my zone, you’re in
St.Shitbags’ zone.’ (Where the AO is a
sieve of tissue.) They have been sending
you patients for years, but unfortunately:
(even dare to throw in a chuckle here,) 'the
new area supervisors have been
reallocating the zones.’ With out overuse,
this has a very high success rate. Mind
you, you are dependant on the AO at the
other hospital being a sieve, and not as
bullshitty as you. If you do get that abusive
phone call from him/her:
Don’t think for a minute that the bullshit
can’t apply to other AO’s as well.
When a dunny’s involved, there are no
friends.
‘What, you don’t know about the new Tell them absolutely anything - but,
zones? Boy you guys are a bit slow...’ always sound sincere. It does no good to
tell the LMO that you can’t accept the
Bullshit your boss patient because the Osteogenesis
Imperfecta Trampolining Squad is in town,
As one can imagine, bullshitting the boss
while pissing yourself laughing. A
can be a risky ploy.
particularly fanciful lie requires skill,
But don’t let that ever hold you back.
concentration and years of experience.
When called before the med super:
Be careful not to go beyond your
‘I said no such thing!’
capabilities.
‘...must have misunderstood’
‘But it’s true! The zones do exist!’
‘’..Oh. I must have been given the wrong Chockers
information.’ Advise them that there is just no point in
‘I've not been well’ sending the patient to you. The department
is chockers with really sick people. With a
New Wards curt farewell, you wave to the empty rooms,
and with a spring in your step, it’s off to
If the usual ‘no beds’ line is getting you
hide somewhere.
nowhere, advise the person to ‘send the
patient up tomorrow,’ as you believe ‘ there
is going to be a lot more beds available.’
(Repairs to air conditioning completed,
wards opening etc.) And there’s going to
be another AO on....remember the guy
yesterday probably did it to you!
The AO on tomorrow is no-one’s friend.

The AO on tomorrow is no-one’s friend

11
 SECTION 2: THRUSTOPELVES
What To Do Once They’re In.
They are on their way
Let’s assume you’ve failed on the first
line of defence, a dunny is on the way, but
there is no need to give in yet. There are
many other tricks up your sleeve to avoid
actually seeing the dunny, despite the fact
they have made it into the department. The
relative, GP or patient knows you’re a real
bastard, and gramps is being wheeled
through the door anyway. (It’s right about
now that you swear you’ll never use the
Rude Approach again.)
Classique
He’s a Dunny Classique. You knew
from the description over the phone that it
was going to be pretty bad, but this is
ridiculous. He looks much healthier than
you do at the end of a shift. And there is a
positive Suitcase Sign - there they are, all
packed and ready for his long stay in
hospital. (Not if you have any say in it!).
The relatives are hard to find
Hyporelativity
If you can find any relatives right about
now you’d be very lucky. They’ve taken off
quick smart. If you do manage to get them
with a rugby tackle, as they fly out the door,
they come out with a rehearsed statement
about ‘doctor’s wages and payment of
taxes’ or some such other lie. (Ever had a
seriously ill patient dumped on the hospital
doorstep? Did you assume the dumpers
wanted to avoid detection by police in
relation to drugs? Bullshit. They were
probably the dumpee’s RELATIVES!)
Anyway, all this has confirmed your worst
fears. (And it’s right about now you’re glad
you used the Rude Approach!)
Dunny Evasion
But, as noted above, you’re not actually
at the stage where you have to talk to, or
examine the beast. One now leaves
Custodian duties, and passes onto the
area of Dunny Evasion. I.e. Not having to
see a dunny, who has actually arrived at
the Emergency Department.
There are four methods of Dunny
Evasion:
Recognition - has the enemy truly arrived?
Passive Evasion - can you get rid of them
with minimal exertion?
Active Evasion - can you move them on
with a little effort?
Hyperactive Evasion - avoidance to the
DEATH.
Be confident. Be definite. Tell yourself:
‘There is NO WAY I am going to see this
dunny!’....
(I) RECOGNITION
What are the signs of a
Classique?
It’s very easy to recognise a true dunny,
as distinct from someone who is generally
unwell. There are many features of the
Dunny Classique which give them away.
Learn them and despise them. Some signs
were mentioned previously. These are the
Positive Suitcase Sign and the
Disappearing Relative Sign.
Positive suitcase sign
Most likely, the next thing you are going to
notice is the smell. Dunnies smell bloody
awful, mainly because they are unfamiliar
with a process known as Washing. Hygiene
is a lady on drugs. They have some sort of
innate horticultural instinct - they like to
GROW things on their bodies. Sub-
mammary fungal gardens, scrotal flea
circuses, sub-ungual faecal - based
bacteria colonies and oral micro-organic
zoos, all go to make up the unmistakable
odour of the Ponging Pongid. You can be
resting quietly at a desk in the ED, when
the distinct pungent smell of the Classique
hits you. Yuck! (You think immediately -
‘Where are the bloody ‘terns?’
Where are the bloody terns when you
need them?
Visual Contact
The AO’s all-powerful optic senses
come into action. The all-knowing glances.
There he is, the guy the GP said was
‘dying’. He’s half pissed, and has just put
out the last of forty cigarettes for the day -
and it’s eleven in the morning! Sure, he’s
got nasty COAD, but who cares? Certainly
not the patient themselves!!
He won’t stop smoking no matter what you
do.
He’s quite used to running around with a
pO2 of 40. The fingers are grossly nicotine
stained, and you could do without the
smegma jam-packed under the oriental
length fingernails. And he’s got his pyjamas
on too; in fact it looks like he’s had them on
for some time. The flannel material, circa
1945, is actually now forming a semi
permanent outer layer of epidermis. The
moccasins he has on have been there
since he stole them from a dead hobo who
was about to throw them away because
they were too dirty for a tramp.
Noises
He is unwell. He is so unwell, he can sit
there and complain about it non-stop and in
great detail. In addition, he can tell you
everything you are doing wrong, how the
world is against him, and how he would
improve society, while continuously farting
at the same time.
If you ever feel a particularly nasty fart
coming on, go and sit beside the nearest
dunny and let fly - it gives them a taste of
their own medicine and you can blame him
for it!
He also wants to know where HIS ward
is. The laughter with which you respond to
such a question only increases his
determination to be heard. He has now
decided he is no longer unwell, he is dying.
Bastard.
Bloody Relatives
As mentioned, the relatives have long
gone. But they’ve left gramps with an
enormous supply of (empty) toiletries,
porno mags, and of course, more
cigarettes. Bloody relatives. If gramps didn’t
have the idea that he was going to stay in
hospital, they certainly gave it to him.
Bloody relatives.
The ‘Illness’
He has a terrible illness. It periodically
undergoes a complete transfer of organ
systems, with new symptoms replacing the
old at varying intervals. This is all
associated with the appropriate yelling,
moaning and swearing. It is not unusual for
him to be experienced when it comes to
complaining about the correct symptoms of
ischaemic chest pain, for example. He has
been asked all the questions so many times
before that he knows exactly what to
complain of.
Look at the THICKNESS of that history -
More than one volume of a history means
MEGA DUNNY.)
I.e. T = CI/IQ x F
CI/QI x F
(Thickness of history is equal to Cigarette
or other vice intake over IQ. The equation is
determined by a constant ‘F’ representing
‘FAAAAARK!’)
Disregard of his symptoms infuriates
him. His symptoms worsen, the moaning
increases, and he tries on a new illness.
Quite silly of him really; the more he keeps
that up, the less likely he is to be seen! And
if you are successful with your Evasion
Tactics, he will certainly not be seen by
you!
(ii) PASSIVE EVASION
The Definition
The definition of passive evasion is ‘the
process by which a resident, more likely an
AO, avoids contact with a dunny, not
necessarily a Classique, while expending
none, or very little, ATP.’
What this means is, you attempt to not
see the vege by pursuing channels which
involve simple phone calls. The success
rate may be limited, but this should
definitely be tried before Active Evasion, as
the latter encroaches far more on leisure
time.
Charity begins nowhere
Perhaps the most poignant form of PE
occurs when a Classique arrives, but you
are not feeling particularly charitable. The
final influence is the fact that, say, some
intern in the ED is really giving you the
shits. Right. Don’t hesitate.
“He who hesitates sees dunnies.”
Slough him straight to the ‘tern. Simple and
quick PE. Let’s face it. Some ‘terns are just
there to be annoying. God put them there to
give us someone to talk about at lunchtime.
Someone to focus our abuse and anger on
in order to reduce that directed towards
patients. And these ones know they are
dickheads, and quite happily expect the
crud. So, don’t disappoint them; give it to
them. And if there is a tern you dislike, what
a nice experience when you’re down! You
know the ones - they’d backstab you to any
consultant if it made themselves look better.
Death to such ‘terns! It’s so lucky that
A.O.’s were never ‘terns themselves!
Some terns must be killed immediately
Arranged Admissions
If some Dunny arrives in ED completely
unexpectedly, don’t presume they must be
seen. Ring Admissions, or the admissions
sister in case it is an arranged admission.
Sometimes these patients, relatives, GP’s
or clerical staff are plain stupid, and
presume everything goes through the AO.
Ambulances get called for an arranged
admission, but turkeys forget to advise the
ambos, so they bring them to the ED.
Let’s face it - Dunnies are shit and the AO
is a blanket.
Get HOT on this.
Have NOTHING to do with these patients,
no matter what ANYONE tells you.
Even the slightest suggestion of an
arranged admission requires an urgent
phone call, long before considering them
the type of person requiring your mystical
talents. Get on the phone, and get them
out!
Risky
One occasionally successful move is
direct slough to registrar. Some Active
Evasion is involved but it’s mostly passive.
Consider this - as usual, you’re stuck in the
ED and pissed off. Your tenth chest pain
dunny for the day arrives. You see that he
is very well. If he has significant pain, he
certainly isn’t showing it. Anyway, there’s
heaps of paperwork to finish off before you
go home, so that is first priority - arrests are
a poor second. Into this situation wanders a
registrar, in a good mood.
A registrar walks in
He’s checking things out before he
disappears for the night. If you’re on your
toes, you’ll recognise the chance, and grab
it. i.e. ‘There’s a patient here I was thinking
about ringing you to see. I’ve been very
busy, haven’t quite worked them out, or
even written anything down.....suppose I’ll
just wake you up when I’ve sorted it out....’
Then act really busy, with some other real
dunny; the registrar will recognise your
plight, and usually......do nothing to help.
But there is a chance he’ll get jack of
waiting to see if he’s going to get called,
and will see the dunny, without you having
said a word to the vege! This is a risky ploy,
as you need registrars on your side; but if it
works, it’s magic. Always be aware of term
rotations and look out for new, young
registrars for this slough. Do not bother if
the duty registrar is very experienced. He
will look at you and laugh - and may never
come back.
PE vs. AE
PE is a lovely experience, but
unfortunately, AE is what is usually
required.
(iii) ACTIVE EVASION.
A touch of class, a touch of work
When they’ve arrived in the ED and
there is no obvious way of slagging them
off elsewhere, you’re a little limited in your
excreting opportunities without doing a
touch of work. The trick is to keep it to a
minimum, to approach a dunny with the
very touch of class they lack.
This is Active Evasion - ‘ridding yourself of
an undesired object via expenditure of
ATP.’
But certainly far less ATP than that used
up in a formal ‘history’, (Tee Hee!), and
‘examination’. (What for?)
HBA Status
So often ignored by residents and new
AO’s - yet so often a blessed source of
relief.
Forget about the type of chest pain they
have - what type of INSURANCE do they
have!!
This is important to ALL RMO’s at some
stage, so get into the habit of asking it
every time yourself. Don’t trust others -
there are many misinterpretations and
assumptions made by those who don’t
really care - and it’s you holding the can,
looking stupid. One of the best ways to
avoid doing too much work is to find a HBA
+ve patient, and get the LMO to do most of
the work for you! They get so pissed off at
having the tables turned on them! (Us
slagging of dunnies back to them!)
Emphasise to these patients that they are
paying good money to have their own GP
looking after them - and not some silly
young upstart like you!
Slough to someone who cares
This Active Evasion leaves you with no
work, happy relatives, (a complete
contradiction in terms!), and some annoyed
GP somewhere who thinks you’re a turd.
(Or just confirms it.) Too much of this will
have the GP insisting they ‘can’t look after
such a case’, (it involves ‘thinking’,
something foreign to the poor G.P., but :
Good G.P.’s are gold!
And that you have to ring the consultant.
This blatant laziness must be immediately
reported to the patient. We’ll do the work,
but have the last laugh. He who laughs last,
puts in the boot.
Think laterally
Don’t accept a simple ‘no’ to the health
insurance question. Remember the many
other categories which may apply.
Workcare
Veteran Affairs
MAB/TAC
Employer
Family
Granny in nursing home - looks like dunny,
but guilty rellies pay for HBA.
Loony in the bin - looks like etc......
I’ve been tempted - regular OD dunny,
have whip around and pay for a month’s
HBA for them, if there is a current deal on
zero waiting time, which sometimes
happens.
Outpatients, again.
If they have arrived, OP may still be an
option. As stated before, OP is dying, but a
good wall thinks of everything - except the
patient’s happiness. Transmission to OP
can be rewarding. This must involve a
certain amount of working up of the patient
for presentation - a classic buff - but it may
be worth it in the long run. It gets them out
of your hair.
another hospital, DO NOT BE RASH. Stay
cool and get on the phone to the other AO
to smoothly attempt to rectify things.
Do not accept any of this ‘now that they’re
there,’ shit, just say ‘sorry pal, they are
already in the ambulance.’
Then get on the phone quick smart to
the ambos and get that dunny out of there
before the wall at the other hospital rings
the ambos himself to check on your story -
which any good AO would. While not a real
obstacle to a real AO, it may just reduce an
already tenuous relationship that exists
between two good Walls.
If relationships are not tenuous, then you
are working too bloody hard.

Be wary of writing traceable letters Registrar Admission

Be ready for this one. Sometimes
Strange advice it may sound to some, but
admissions are worked out between
DON’T write a letter.
consultants and their registrars over the
If you do that, they will be able to trace
phone. These are non-negotiable
the dunny back to you. By the time they
admissions which do not require the ED
sort it out, there is a fair chance that you
staff to be involved. Your function is to sort
will have finished your shift.
the admissible from the non, and in this
If some resident rings from outpatients,
case, no assessment is required.
asking what the hell is going on, rely
Disturbingly, registrars are in the habit of
directly on your first instincts -bullshit. i.e.
not informing the AO of this type of
‘Didn’t you get my letter?.......hang on, it
admission. This is extremely rude and
appears to have been left here by
annoying; especially with all the unseen
mistake....they had a problem THE
favours we are doing for them. We may
INTERN suggested that he’d heard you
agree to do some minor test or procedure,
were interested in..........the letter will be
but that’s it. In future, we may not be able to
there in a minute.........’ then get the intern
trust our ward brothers and sisters - so if
to sign a hastily drafted letter, explaining
this happens, a polite word to the registrar
that OP hates you, and wouldn’t accept a
is needed, like: ‘Piss off prick!’
patient in your name. (Goodness! The
truth!)
Desperation time
Wrong Hospital Neither PE nor AE has worked. It’s
desperation time. To avoid a formal patient
It does happen. Especially when your
assessment, and the terrible workload that
hospital is on a direct route between two
ensues from that, it’s time for Hyperactive
others. The ambos may wrongly presume
Evasion.
that yours is the correct hospital, when in
fact what the patient requires is provided
further up the road - closer to the city for
specialised medicine, further away for
some sort of rehab process, or to be closer
to relatives. Be alert for the possibility
through comments by patients or relatives.
This is one time to actually listen to them. It
is usually obvious fairly quickly, but you
need the information quickly to avoid any
patient contact. Once the problem is clear,
a certain amount of work is still necessary,
even though it sounds as easy as saying
‘Go away, idiot.’ The thing is, every hospital
has a bastard like you. If a mistake has
been made, and the dunny is expected at
 Silly evasion technique
(iv) HYPERACTIVE EVASION
A Reputation At Stake
There is no way you want to see this
guy. You have been on the phone to
relatives, GP’s and numerous colleagues
for hours. The dunny has still fronted up to
the ED, and no phone call, inter/intra
hospital slag off is going to work. But still,
you are NOT going to formally see this
bastard. It’s time to put your career on the
line; reputations no longer have any useful
purpose. You are going to send this guy in
any direction, and however far your talents
will take him. Hyperactive Evasion is rarely
used - it is reserved for that dunny which
you particularly despise; the one you have
seen every day this week, and twice today.
Use it sparingly, but use it if necessary.
Hanging Labels
As usual, there is nothing wrong with
this vege, but you have to hang a label on
him to get rid of him. Such labels may
include ‘discharged himself’, ‘specialised
treatment needed’ or ‘no work needed.’
They speak for themselves, but let me give
some illustrations to highlight what I mean.
Discharged Himself
‘Hello Mrs.Smith? Gramps is in a taxi on
his way home. No, we couldn’t stop him.
Sick? No, he didn’t look sick - just
discharged himself, saying he felt fine.
Well, yes, he does mention some chest
pain. I asked him to stay, but he wouldn’t.
Just kept saying over and over how great
he felt - or that’s sort of what it sounded
like....: By the way, if you’re missing his
blue socks, you might have a look down his
throat........Same to you.’
Specialised Treatment Needed
‘Hello, Royal Women’s? Got what looks
like an eight-month pregnancy here for you
with mega-complications. Terrible morning
sickness - has vomited every day for 15
years. Despite quite large breasts, actual
breast-feeding appears likely to be
unsuccessful. There’s an endocrine
problem too, I’m afraid. A case of shrunken
gonads; plenty of oestrogens though! Now
we know you don’t really need these
hormones after the first trimester, it’s just
that we doubt that there’s a viable placenta.
... Anyway, he’s on the way.........same to
you!’
No work needed
‘Hello, Ballarat? Got this guy here with
terminal carcinoma who wants to be closer
to his relatives for his final days. It seems
they all come from up there. One of them
actually appears to be one of your
surgeons up there. Which one? Ummmm, I
forget the name. Anyway, can you take
him? No? Well unfortunately he called an
ambulance himself and is on the way - I
was just making a polite call. Sorry about
that, but let’s face it - he’s not going to be
with us much longer! (optional – ‘but he’s
going to be with you a hell of a long
time!!’)......same to you!’ [He gets there and
they can’t find any relatives. Fortunately,
your diagnosis was incorrect, and he lives
30 more years! Then 30 years later, an AO
from Ballarat rings Melbourne to transfer a
guy back to be with his relatives while he
dies. One of your well taught students tells
the Ballarat AO to get stuffed, then adds -
and the same to you!]
Other Hyperactive Evasions
1. Kill the patient.
For: Dunny no longer a problem
Against: Lots of paperwork
2. Kill relatives and put dunny in taxi.
For: No-one to care
Against: More bodies to explain
3. Blow up the hospital
For: Go home early!
Against: No more pay
Go home early!
4. Just go home
For: Can watch telly
Against: Not much on
5. Use naturopathy
For: They’ll die
Against: It might work
6. Feign unconsciousness
For: Spunky nurse might treat you
Against: Intern might treat you
7. Scratch your genitals and
announce you are HIV positive.
For: Eases your scrotal itch
Against: Nothing. Do it.
 SECTION 3: PARTURITION
Getting Them Out.
Production
You didn’t stop them getting there. You
couldn’t get rid of them once they arrived.
You are now in the unfortunate situation of
having to go through the traditional
Product Handling Process. You must now
shift the dunny. Work reduction is vital to
survival. At this stage you are not a terribly
impressive Admitting Officer, but if you can
master the post-assessment slag off, you
well on the way to improving your standing
in the eyes of similarly heartless,
determined peers. You are becoming
registrar material.
Refusal To leave
We obviously ignore the soul-destroying
process of talking to/examining the ponging
pongid, for now, and go directly on to the
far more important aspect of getting rid of
them. The appropriate tests have been
ordered - all normal of course - but the
dunny refuses to leave. Or possibly gramps
has accepted the fact that he’s going home,
but now the rellies have magically
reappeared.
The rellies reappear at the suggestion
that Gramps is going home
They spout the usual rubbish about the
inadequacies of the hospital system, and
how it doesn’t allow them to nick off and
have a good time when they are sick of
gramps - but not sick of his money. They
often add how our careers are as good as
dead, if we don’t keep gramps! (What a
joke - they couldn’t influence a rabbit to
root.)
Don’t fear relatives; they couldn’t
influence these two to hump
Anyway, this process is ED Induced
Forced Responsibility. Or, ‘we’ve looked
after him for 6 months, and now it’s time
you lazy overpaid doctors looked after him.’
They have some silly idea that once
someone is at a hospital, they can’t be sent
home. They can’t cope with my response to
this theory of Automatic Attendance
Admission - my response being, of course,
politely.... BULLSHIT!!!!
Anyway, given the situation, the challenge
emerges for the AO. Work out how to weed
the Department of these pests and their
relatives by one of three methods:
Private Excretion - push the turd out to the
family.
Public Excretion - push the turd out with
anyone.
Absolute Constipation - you just CAN’T
push that turd out!
(I) PRIVATE EXCRETION
The Disaster Of Momentary Care
The first area to consider, as regards
private excretion, is how the family is
placed for taking gran home with them.
This is crucial. Watch how the family
reacts to news of granny’s illness. Do they
look overjoyed? Hmmmm - leaves us in
trouble. Or do they look the slightest bit
caring? If so, they are gone! As far as you
are concerned, Granny is as good as in the
back of the station wagon with the dog.
Explain how Granny can move in with them
for a while. Either until she gets over her
cold, or snuffs it. (Try and put this in a
tasteful manner.) The suggestion that a
family should look after their own Granny is
usually followed by an astonishing tirade of
abuse from them. Fancy you presuming
that a family should care for their own! Only
primitives do that! It never fails to amaze
me how little they care, or listen to our
assessment of the situation.
The Patient Has A Mind?
Never lose sight of the fact, no matter how
completely improbable, that Granny
actually does have her own brain in there
somewhere.
The patient may have a brain or it could
be in a bucket – talk to the bucket
Perhaps she actually wants/insists on
going home. It is very hard to believe she
has her own mind, and doesn’t agree with
her obnoxious, wealthy daughter in law,
who is married to her wimp of a son.
Remember one of the ALL TIME great
enemies of the Admitting Officer - the good-
looking, wealthy yuppie who doesn’t pay for
health insurance.
The ‘not quite rich’ expect everything for
nothing. They are the same sort of people
who complain loudly at restaurants, live
beyond their means, and can never accept
the fact that they are not the people they
see themselves to be. They also pretend to
care for granny when they obviously don’t,
and they ignore any independent thoughts
or behaviour by Granny. Support Granny in
her quest to go home!
The Surprise
Far less frequently seen in the excretion
scenario, is the great surprise. One spends
hours on the phone organising some sort of
geriatric placement for Gran, presuming all
relatives are pricks, only to be told - ‘But
please Doctor, we really want her to come
home with us!’ I don’t care if they are truly
concerned or want her for her money -
they’ve got her. You should have spoken to
them first. They may have brought Gran to
the ED, only to make sure there was
nothing seriously wrong with her - or if
inheritance is involved, hoping something
seriously was!! Either way, this is Accepted
Relative Reassurance. Note that this is
opposed to Unaccepted Relative
Reassurance - the latter being basically,
‘We are worried about Gran, and fear there
is something seriously wrong - and if you
can’t find something wrong, then we will
find someone who CAN!’
The Obscure Rellie
Rarely, just when you think that all hope
is gone, and you may have to, (shudder,)
call that prick of a registrar who always
gives you a hard time, the beloved Obscure
Rellie appears from nowhere. These are of
two types: firstly, a niece or nephew hears
of Auntie’s plight, and despite the fact they
have been unaware of Auntie’s recent
problems, they feel they should look after
her. They care nothing for her wealth, and
have seen her in the past 2 years. As
suggested by such a story, they usually
appear after an admission, so are of little
help to ourself when trying to piss her
off.....sorry, I mean arrange her placement.
But occasionally they are hanging around
the waiting room in the Emergency
Department. Frequently, they are very nice
people.
The second type is far more common,
and far less pleasant. They haven’t seen
Aunty for 30 years. They hear she is
unwell, and would like to care for her. It is
not unrelated that they also know she is
part owner of a block of flats in Toorak.
Family ties suddenly firm. The test in the
Obscure Rellie situation is - how long since
you have seen Aunty?
Lawyers are often BOR’s
Hesitation or a figure greater than 5 years
is BOR +ve. (Bastard Obscure Relative.)
A Feel For Rellies
Excretion via private passages is not
common.
Even so, a good assessment of the
situation is invaluable. A good Feel for the
rellies could easily prove the difference
between an inexperienced Admitting Officer
calling a registrar for admission, while the
more accomplished, thinking AO is waving
Aunty Goodbye.
(ii) PUBLIC EXCRETION
Get Thee To An Institution
Typically, the relatives have either
disappeared, or are adamant in expressing
their disinterest in Granny’s welfare. This
then gets dangerously close to the worrying
process of organising an admission. The
next slough to try is Public Excretion. i.e.
transfer to another area of the hospital,
(excluding wards, of course) or an
institution elsewhere.
Slough to elsewhere in the hospital –
e.g. the car park
These institutions include hospitals
closer to home, more specialised units,
loony bins, geriatric hospitals, or the private
zoos. (nursing homes.)
Previous Connections
Check in the past history in case they
are a recent inpatient at any hospital, bin,
home or zoo. This may lead to a quick,
rewarding slag-off. When talking to the
appropriate AO, Matron or whatever,
remember to make it a convincing story -
no matter how untrue it has to be.
Emphasise the fact that the patient is NOT
desperately ill, but needs some sort of
institutionalised care. (You’d love to take
them but you have that old beds problem
again...) This may have limited success if
you are pitting your skills against a similar
bastard to yourself - but if they’re nice,
bingo! They’ve got themselves a dunny!
In such circumstances, anything goes.
For example: say you have an innocent,
demented patient; ignore his harmless
nature and tell the Bin AO that this guy is
wrecking your department, and is on his
way to them as you speak. Apologise, but
point out it was just out of your hands. Add
that you have just sedated the patient for
the trip, (so that they are relieved when
gramps gets there and is his usual happy
self,) then give him a shot of normal saline
for the record, so that an injection is
documented.
Transfer Blame
If a transfer fails, use the opportunity to
make yourself look better. Tell the rellies
that if you had a bed, (and the place you
tried had many), you would accept gramps.
Age is no barrier to a slag off: this kid
can’t speak, and is incontinent – he’s
good bin material.
They are just plain nasty and uncaring;
unlike you. Turn the rellies hostilities on to
the other crowd. This stops them abusing
you, and may lead to pressure being put on
the other place to accept gramps. Point out
that you’ve done everything you possibly
can, and that you can only do so much
against these horrible people.
Don’t allow a little thing like loyalty to other
AO’s get in the way of blame transfer -
they’ll do it to you every chance they can!
Forgery
Send them to Outpatients, or any similar
clinic, with a referral letter signed in the
name of a resident who is on holidays.
An Open Mind
Never assume that just because a
patient is not producing florid psychotic or
neurotic symptoms/signs that they can’t be
slagged off to a loony bin or Psych. ward.
Keep an open mind and send them some
more remote possibilities such as dements,
social problems or old loonies with minor
medical problems - after all, that’s what the
psych AO is doing to you. Some dunnies
come into the ED with mild to moderate,
say, CCF, but their main problem is
dementia, and forgetting to take treatment.
Take a long, hard look at the patient for
possible avenues of escape. While a psych
AO may sedate a loony to get you to accept
him with a pissy chest infection, fight back!
Give your dement with CCF some IV Lasix
and clear him just enough for the psych AO
to have to accept him.
Social Problems
Occasionally, it is helpful to get the Social
Welfare people involved. They are usually
very good and helpful, and often are in the
ED offering their services.
The bulk of the people seen in the ED have
at least some underlying social problem.
Including staff.
Get the social worker to see the psych
reg while she’s there
To a certain extent, if the social problem is
corrected, the medical problem is partially
alleviated. With the social situation
improved, one may find that a suggestion to
look at the medical problem at a later date
is happily accepted by the dunny. Basically,
what it means is that you’ve done more for
them than most other people would or
could - and as a bonus, you’ve slagged
them off, and the medical problem will likely
become someone else’s.
A Warning
Beware sloughing patients to other
institutions if you are at a hospital which
rotates through these.
If you are soon to work in one of these,
you may commit the cardinal sin of
transferring to yourself. If this happens,
reverse what you did to get the patient to
the, say psych ward, (stop Lasix, give
sedatives) and send them back to the ED!
(iii) ABSOLUTE CONSTIPATION
Utter Failure
You’ve tried everything, and you just
couldn’t get rid of that dunny. The absolute
last ditch, desperate, horrifying and
completely unacceptable solution, is.....,
(gulp) ... admission. They are all going to
call you a sieve.
Nothing has worked and you are going to
have to refer that patient to the appropriate
resident, registrar or consultant. If you have
made a decent attempt at sloughing the
dunnies by the previous suggestions,
there’s no registrar worth a pinch of shit
who’ll get upset about you calling him. If he
does, he’s just an arsehole. However, they
may get annoyed if appropriate tests
haven’t been ordered, or obvious treatment
hasn’t been initiated.
Premature Admission
Don’t forget that registrars are very good at
sloughing off patients.
So if you have presumed a dunny is going
to be admitted, and started doing some
paperwork or such in this regard – be
careful. You might find the admission
doesn’t eventuate through some neat trick
performed by the registrar you called to see
the patient. Take care to avoid unnecessary
work in this manner. If such a neat trick
happens, again, learn from this superior
being.
Break Down
Even considering everything that I have
said, if the registrar is the aforementioned
bastard, or has just had a very bad day, he
may get annoyed no matter what you have
done. In this situation, just break down and
cry. This reminds them of many days in
their past as Admitting Officers themselves.
They will then pity you. For a millisecond.
Either way, all has failed. The registrar is
called; the dunny slagged off by him or
admitted. He may be upset. But show you
have tried everything. The patient is
admitted to the ward and becomes
someone else’s problem.
 SECTION 4: YOUR FIRST DAY

(I) YOUR FIRST DAY IN THE E.D. an interesting murmur – you can hear creps
all day long with a crap ED scope.
The A.O as king
I can’t get away from the fact that the
hospital tends to revolve around a real
Admitting Officer.
No matter where your first rotation is,
you will have plenty of contact with the AO.
He decides all admissions – he decides
who comes in, who gets them and who
doesn’t. He decides when the elective
patients suffer. Taken to its logical
conclusion, he runs the hospital. This is
even closer to true in the rural hospitals.
Whatever, when you start at the ED, he is
the centre of your universe. The AO is the You won’t need good guessing tubes
source of all your knowledge and activities around dunnies
in the ED. You can learn what is successful
Get ready for a range of illnesses.
and what causes failure. Learn to minimise
Triage and the AO try to keep crap out, but
work, avoid unpleasant patients, get along
inevitably, some GP stuff slips through.
with others and have some fun along the
Minor fractures and illnesses requiring
way.
treatment can be interesting and a good
The AO may be a consultant or a senior
learning experience. Look forward to them.
resident/registrar. The AO sifts the ill from
If an admission gets to you, consult the AO
the dunnies. Junior staff are mostly
for evasion or excretion techniques.
involved with the boring stuff, but are
encouraged to get involved with things like
multitraumas. Watch how the AO organises Be careful
patients, minimising dunny contact. You need to be a little more forceful
(Hmmmm) with nurses here compared to
Preparing for Day 1 on the wards – they expect it from good ED
residents. Wimpy residents are sneered at,
Sorry. You can’t really prepare for this.
and recovery is virtually non-existent from
You need a lot of your practical knowledge
there. However, retain reasonable modesty;
and skills that you don’t have yet.
but be very careful here saying ‘I don’t
Expect to see crap only, so stress
know’, or ‘I’m not sure’. Be polite but firm
should be not as bad as, say, a surgical
with your orders and your lies. Ask the
rotation. It’s unlikely you’ll see someone
senior residents constantly for help – better
needing admission, but sometimes minor
to annoy them than stuff up at this stage.
head injuries sent to you are skull fractures,
Get confident later when you have learnt to
for example.
pretend. Join in major resuscitations
Hmmm. Maybe you should panic a bit.
whenever you can. Ignore dunnies to do
this.
Your first day
Be on time, especially if there is a ward
round at the start of your shift. But soon you
will be effectively your own boss – if you
survive. No need to bring your own tools,
except maybe a stethoscope and torch -
most of the holes are dark. But if you have
a good stethoscope, leave it at home.
Someone will only steal it (the AO usually)
and anyway, no-one here is going to have
This is your boss
Hide
Hide when you feel you need to – you are
scarcely a vital cog in Emergency.
Rest away from stress is vital for all
residents. It’s so hard to do when you are
more senior that you should take full
advantage of it now while you are useless.
Start slowing down hours before your shift
finishes. False bravado is silly, and you will
be surprised at all the paperwork and
follow-ups that take up your time. Avoid
new patients at this time no matter how
guilty you feel. There are no rewards for
heroes here. Trust me. Hand over patients
as soon as possible – especially look for a
new, gullible dickhead coming on so that
you can get rid of them and piss off early.
This will rarely happen the whole term, so
grab it while you can.
Talking
Talk to anyone in the X-ray department
– a lot. Even just the receptionist can
accept quick bookings for you and help you
get rid of a dunny quickly – so chat to
everyone.
And, wank though it is, when discussing
stuff, call Emergency the ‘ED”. Everybody
prefers the old familiarity with ‘Emergency’
or even ‘A&E’ or ‘Casualty’ but ‘ED’
consultants are trying to build their own little
ivory tower to match the real consultants,
and they insist on being pedantic about
this. Appease them only while you are
there.
Whatever rotation you are in, pretend it is
the branch of medicine that you have lusted
after since the womb. Be honest and can it
on the next rotation.
If they piss you off, keep calling it
‘Casualty’. But not if you want to survive.
(ii) YOUR FIRST DAY IN
SURGERY
Bless their little hearts
Surgeons appear to be pre-selected for
being bastards; rude, uncaring, insensitive,
hard-working, skilful and angry bastards.
You must be especially prepared for them.
Before you start the rotation, you must
know all about your unit. Spend at least one
day with the resident you are replacing and
listen to everything they say. If the surgeon
can see you around at this stage, tell him
you have come in on your own time to be
ready as you have ‘always wanted to work
for him’. Try not to vomit.
Meet the outgoing resident
If the resident has forgotten about being
an intern already, he may try to fob you off.
Ignore him and just turn up. He’s just fed up
and needs you to insist. He has much
knowledge to offer.
Ask the resident for information on each
surgeon’s preferences re wound drainage,
fluid types, wound care, analgesics,
mobilisation, feeding and any other
peculiarity or bias. This is vital. The
surgeon considers his way the only way
that works. He respects his colleagues but
secretly, or not so secretly, thinks they are
idiots. They often fight because of this.
Make sure you watch these fights – they
are so egotistical, it is hilarious.
Surgeons hate their colleagues
Do not mix up individual surgeons.
When you are with the resident, make sure
you say hello to each patient on the ward,
learn a little about each (take notes);
especially the diagnoses. Find out the main
investigation results still pending. Especially
the surgeon’s favourite tests.
Write down everything the resident says.
Learn specific likes and dislikes of the
surgeon; including personal stuff.
A few days before
The week before, practice putting in lots
of drips and read up on fluids in and out.
You must be hot on putting in drips,
prescribing drugs (analgesics) and doing
fluid balance. Be ready with intelligent
questions you already know the answers to.
Your questions for the surgeon should be
relevant, yet vague. And use small words
around Orthopaedic surgeons. Check the
ward round time and operating times. Read
up on the types of operations planned for
the following week. Be ready to turn up
early for everything. Surgeons don’t have
anywhere near as much influence as they
think, but an angry surgeon means a
miserable day.
Use small words with orthopods
The good thing is they are a bit brain
damaged by drinking, so they have a short
memory span. And they don’t tend to keep
silly grudges – they can’t remember who
you are. (We are the opposite – the alcohol
and hooch hasn’t affected us yet).
Surgeons have little short-term memory
The night before
Relearn everything from the resident
and all the other sources. Make sure you
have all the right tools; you don’t have any
time to go back. The tools needed are more
than in ED. Stethoscopes are vital to trick
the surgeon. A flashy stethoscope, even
used on the wrong side of the chest,
impresses surgeons. They know nothing
about guessing tubes. Mention ‘murmur’
and they nod reverently. You’d better
explain what they are – they haven’t got a
clue, and don’t want to. They slag-off all
their crook patients to physicians – they
treat them as interns. But beware of
surgeons who have a pet interest in non-
surgical areas like chest infections – they
have a little knowledge and think they are
experts. Make sure you humour them.
The Surgical Registrar
Get to meet the registrar as soon as
possible. Greet them with respect and ask
exactly what you need to know and say.
The resident knows more about the basics,
but the registrar knows the major stuff. He’s
a bit more aligned with the surgeon with all
the bum kissing he has to do. But if he’s a
reasonable person, he will guide you – if
you are humble enough and very keen.
Cross him and you are all alone. Do exactly
what he says.
You can lie to surgeons (it is to be
encouraged), but never lie to a registrar.
Unless you are the AO.
Tell him if you do not know something as
soon as possible so he can help you make
up a bullshit story for the surgeon. And
anyway, you can say anything – surgeons
never listen to interns.
‘A wizard cast a spell on the path
results’ (The surgeon never listens
anyway)
Meeting the surgeon
Greet the surgeon and be upfront. Then
disappear. He won’t be impressed by
cleverness on the first day. Or year, for that
matter. He’ only impressed when you’re a
registrar. Before that, all of us are scum.
Speak only when spoken to, and
apologise when offering helpful information.
At every opportunity, express your eternal
interest in his professional and private
interests. (One wants to be a surgeon or
one is an idiot). Nod knowingly when he
talks of all other areas of medicine being for
retards – but forget it immediately; you will
need those other people to slag off patients
to.
Never forget your place in the hospital – the
bottom.
You should be quiet, respectful and
modest, yet always ready to burst out with
immature energy. It’s expected. If the
surgeon says nothing, good. You are being
tolerated.
After the ward round
After the round, just before theatre, you
have a few minutes to do a days work. Run
beside the registrar as he goes to theatre
and ask him the 100’s of questions you now
have. Ask him what the important things to
get done first are. Then run back to the
ward, do it all, and run back to theatre. No
matter how busy you are, the surgeon
insists you are in theatre, and gets pissed
off if you’re not. Then he just ignores you
for 5 hours.
Surgeons get angry when you’re not in
theatre – and angry when you are!
Theatre
When you get to theatre, do not sit with
the surgeon and registrar – go and sit with
any other scumbag that’s there.
Unfortunately, the surgeon will sometimes
get pissed off when you’re not hanging
around to get his pearls of wisdom; but
mostly he doesn’t want you there. You can
only learn by trial and error. Sorry.
Make sure you put up all the X-rays in
theatre. Ask the anaesthetist if he needs
you to do anything – all sucking helps
eventually. And greet the patient, then draw
on him to mark the side if appropriate. Then
start scrubbing before anyone else so that
you do it twice as long as them – you might
have a chance of doing it properly, then.
Don’t stop scrubbing until the surgeon is
putting his gown on. Go into theatre and
hide in a corner until the nurse calls you.
Smiling, of course. Ask the nurse if you
need to glove yourself – look pleadingly, as
if she gloves you, you won’t stuff it up. Tell
her you will do anything she asks; offer a
name and see if she’s interested. Probably
not. Tell her you are new – as if she hasn’t
worked that out yet – and that you are
reliant on her for everything. Add that you
are not a smart-arse like the other intern.
Glove and go back to your corner like a
statue.
Do not help until asked – you will only
stuff it up.
An intern found in a corner of theatre a
year later, still waiting to be gloved
If you do stuff up the sterile draping,
everyone hates you as it all has to be done
again and the drapes etc might not be
ready for a second try. This is a disaster.
You’re stuck here all day with these people
that hate you, you can’t do your ward work
and the whole thing is going on even longer
because of you. So don’t help! If there is a
disaster, don’t give up hoe – it happens all
the time with new ‘terns. It’s a completely
new day tomorrow – remember the
surgeon’s memory?
During the operation
Do not talk unless asked. Ask one or
two very well thought out/prepared
questions if the opportunity arises. Hold the
tools firmly until your hands are numb –
then hold them tighter; you don’t want to
relax and put the surgeon’s hands through
an artery. Do not try to help.
When an intern helps, it makes the surgery
longer.
Remember, you are a surgical statue.
Ask a relevant question when you’re
finishing up – the surgeon is happy then as
the registrar will close up. But remember,
you are now the registrar’s shit-kicker at
this stage. Help him and talk about all the
ward stuff you have to do. Ask to close the
skin if you can. But hope he says no – it’s
only another chance to stuff up and take
longer. You can sew up skin any time – not
now. You will be a lot more efficient towards
the end of the rotation. See, you get good
at one thing, and you’re chucked into a
totally new, devastating environment –
that’s the plight of the ‘tern.
After the operation
Stay in the theatre when the closing is
finished. Help to clean up everything – it’s
your mess. Even if the surgeon is waiting,
do this – the good side of the nurses is
vital. And if the surgeon knows you stayed
to put the dressings on correctly, you’ll be a
mini hero. They are paranoid about their
dressings. It’s one time when tardiness is a
blessing. Even if you just sat in theatre and
cried, tell the surgeon you’re late because
you put the dressings on. While running
from theatre, write up the operation notes
and post-op orders as the other resident
told you. If you’ve forgotten, appeal to the
registrar for help – you may or may not get
it.
Tell him you did the dressing, not had a
sook
If the surgeon is holding court in the
tearoom, it might be acceptable to ask him
some details about the operation for the
notes – but then again it might not! But get
the operation notes right – this is legal stuff,
the stuff that now runs our lives. Stuff that
surgeons are scared of – perhaps the only
thing, except an empty fridge. If you are
sitting in the tearoom, do not eat until told
to. As soon as you take a bite of something,
the surgeon will run out to the ward.
Bastard. Review everything about the
previous patient, see them in recovery, then
check the next patient and start it all over
again.
The whole time in theatre, look to the
registrar – his eyes and actions will tell you
if you have done something wrong or
haven’t done something. He is your guide.
Love him and your love may be returned.
Love your registrar
He is truly half a surgeon – learning to
be arrogant, yet still one of us. With them,
the earlier rudeness appears, the better the
surgeon and the poorer the registrar. But
most are good guys. I think.
Clinics
Some hospitals still have some clinics
like outpatients, pre-anaesthetic
assessments or fracture clinics. Or you may
have your own private clinic if the surgeon
sends patients in to ED for you to write a
prescription or something.
When in any of these clinics, openly
select the easiest patients to see –
everyone expects it here.
Constantly annoy the registrar with
questions. His anger is irrelevant when the
patient might go home with hopelessly
incorrect treatment. But don’t ask the
surgeon – you don’t exist, remember.
If the surgeon has you seeing patients
with him, for safety sake, make sure
imaging is up and ready to view; or at least
ordered. In this situation, the surgeon likes
to be asked questions – it helps him to
ignore the patient. Teaching means he can
treat a dunny like dirt, so this breaks the
questioning rule.
And follow up all the orders you are
given. Do everything you are told, by
anyone, without question. If you are told the
wrong thing, do it – that other person can
be blamed later. It’s best to not take the risk
of not doing something important. You are
usually wrong anyway, so do it their way.
And the problem normally turns up in the
future when you’re not around – so who
carers?
Once in a new rotation your previous
one is of no interest to you.
(iii) YOUR FIRST DAY IN
MEDICINE
Compared to many other rotations (e.g.
surgery), this is a bit of a bludge. Sure, the
standard of patient tends to drop as you
see all the dunnies ED couldn’t slough, but
the consultants are nicer and smarter.
You have a reasonable amount of work,
but the pace just isn’t there as when you
have to operate. There is a hell of a lot to
remember about each patient, because
they sit there all day having every test
known. And all sorts of treatments –
including for all the side-effects of the drugs
they are given. So you can’t learn all about
each patient prior to starting in the medical
wards. It’s probably only worth a brief chat
to the old resident, instead of a full round.
Consultants
Physicians, wisely, don’t expect you to
know a lot like the surgeons do. They
actually accept that all people have
limitations, especially ‘terns. They even
admit to not knowing things themselves!
They talk about how they are often learning
new things – unfortunately though, it’s all a
bit of a front; they are fully up themselves
too, when you get down to it. It’s all just
their ‘friendly act’. But that certainly makes
us feel a lot more at ease. They tend to
chat rather than order, but you must still be
competent or they get really angry and
suddenly turn on you. So don’t blow a calm
rotation by being lazy. Treat the consultant
with respect – they act sort of sage-like,
and want to be seen like that. They see
themselves as little gods dispensing
knowledge to the grateful resident, They
pretend to learn things for their own
amusement, considering you in on the joke.
As if they could really not know something!
It’s very confusing, but you have to learn to
play their stupid game – it’s worth it for all
the free time you’ll have if you do it right.
Physicians are shit-hot at listening to
murmurs
Registrars and tests
Registrars are a calmer bunch here. The
huge number of dunnies doesn’t worry
them – they are a bit misguided as they
think they can learn something from them
that will help them pass their exams. Oh
dear. You have to feel sorry for them.
Anyway, they like to order lots of tests
looking for interesting conditions. They
never find any. Any AO could have told
them that. Though more pleasant than
surgical registrars, they can become very
intense when trying to find an interesting
medical condition in a dunny. They want as
much knowledge as they can get and tend
to over order tests. So here, you can
basically order what you like without getting
in trouble. Physicians try to make a half-
hearted effort to keep the number of tests
down, but they are interested in finding
something more than COPD too. So it all
goes round.
All tests on dunnies will be normal, or
abnormalities will be untreatable – do
you order them or not?
Lots of tests can be very bad for us –
lots of work, and tests that are all normal, or
find something that just increases your
workload, or does nothing more than keep
dunnies longer. And they are already near
impossible to excrete from medical wards.
So perhaps you should just pretend to
order lots of tests – you may not like the
results. What difference does it make to a
dunny? Make sure the tests you order are
only ones that will come back normal. At
this stage, it’s a hard call for an intern.
If you go looking for problems in a
dunny, you’ll eventually find them – so don’t
look.
Referrals and slag-offs
One big exception to the rule of non-
testing is if you may be able to find a non-
medical problem that may require transfer
to another ward – say, surgical. (The
surgical people will try and do the same
thing in reverse, so get into it!). When you
find something, order a referral and tell your
physician that the surgical problem you’ve
found will require surgery and that they will
need to be transferred. Get the ball rolling
before the surgeons realise it. Then when
the surgical registrar arrives for the consult,
tell him your physician insists that the
patient be transferred. Depending on the
registrar, this could work. Make sure you
exaggerate the problem so that the
surgeons can’t offer conservative
treatment. Start arranging the transfer
immediately and tell the nurses.
Sometimes a process started can’t be
stopped.
One down and many, many more to go.
Medical Denies
The actual dunny usually has some
nebulous or boring condition of little interest
except to students. So it is an excellent
opportunity to learn about things like chest
X-rays, ECG’s, more detailed pathology
tests and drug effects.
If a dunny has something of interest, use it
as a learning process in case later you
meet someone younger or more
salvageable.
This squiggle is an ECG. It is known as
an EKG in the USA to stop interns
calling it an electrosardiograph
But this is rare. It is far more important
to learn how to avoid accepting dunnies
and how to discharge ones that have snuck
through a sieve AO or registrar. Assess the
dunny with your registrar and watch him in
action. See him reject dunnies in the ED or
excrete them from the wards. See actually
what makes a dunny, and who is really
crook. This is such an important lesson.
Many medical dunnies are pisspots, as
you should know from your student days.
But you can’t just ignore them, because
there is so many.
You must know everything about COPD
and Alcohol, and their complications, as this
is what you will do all day.
Sample of dunny chest x-ray (small dot
is the liver) and on the right is the brain
If you know these, you will be an expert
at most of your patients’ progress.
If you know lots about many rare
conditions, you are useless.
Don’t bother testing for one of these;
there’s usually only an old shoe there
You need to keep a very close watch on
your numbers in the ward. This is an
indicator of how successful you are. But
don’t go discharging patients that are
friends of the consultant, have something
interesting or the consultant has known for
years. They get pissed off if you do this.
Keep your registrar informed of pending
discharges so he can approve them.
If you work hard together to keep dunny
numbers down you will have stacks of
spare time to sit around the caff, piss off
with someone covering you or do a bit of
reading. It doesn’t just happen; you have to
work at it.
That AO again
Always go over dunny options that the
AO uses – so you might be helped by
asking his advice sometimes. But make
sure it is a wall. Even adjust your roster to
fit in with the walls in the ED, if you can.
The surgeons cop trauma, and have no
way they can argue. But physicians get
degrees of illness and it is very much a
subjective decision as to whether they are
admitted.
Admissions of medical dunnies are by
choice – choose ‘no’
Try to learn what factors the AO and
your registrars took into account when
admitting a ‘dunny’. They may be medical,
social or emotional. They may well have
just liked him. Seriously. Scan the notes
both these people wrote.
Common sense
For a chest pain to get in, everything
must be tried to find a non-cardiac
diagnosis. Hopefully a surgical one. For a
chest infection to get in, they have to have
something like seriously crook blood gases.
For a collapse to get in, with know
interesting diagnosis, well, they just don’t –
if your AO has balls or ovaries.
RICHH
Scan the notes – why was the dunny
admitted?
An acute brain syndrome should be tried
on the psychiatrists first – especially if a
new registrar has just started. Hell, they are
trained doctors too, you know – they can
handle a little physical illness as well,
surely. And so on it goes. There is no home
for a dunny, so give him one away from
you.
Because your medical rotation should
be so slack, get into the habit of covering
each other, and maybe even other units.
You can have an afternoon off, and you can
get some favours owed by other interns
when you need to call them in during a
busy rotation.
Friday arvo medical ward round
Medicine may be boring, but you can
always make a rotation interesting.
Have fun trying to excrete patients no
one else could shift. When it comes to
these cases of Absolute Constipation, the
social worker may be your most valuable
friend. Or whoever else in your hospital
places dunnies in homes. Keep in daily
contact with this person, under or over
emphasising the dunnies problems as is
appropriate. Watch waiting lists and
pounce. Tell these people whatever they
want to hear. It doesn’t help your career
much to knock dunnies off but remember:
Doctor Death is the registrar’s favourite
intern.
Say no more.
The intern of the year 1905 to 2105
Have fun!
It all seems to be nothing but worry and
complications. It’s not! There’s going to be
great times. It’s just that the problems can
have such dire consequences that they
must be emphasized. And that’s something
else you must learn – to cope with the
stresses and be able to laugh when no-one
else can.
Laugh when no-one else can
Trust me, we all learn this most vital
skill. There are some ways you can
maximize this learning.
During the Intern year there will be
problems – that is expected. But there will
be many times of exhilaration and pleasure.
These will increase in frequency as the
year goes on, until second year when
overconfidence leads to a big or small
downfall. So be careful. Colleagues will be
a source of joy and disdain. You will survive
– except one or two who just don’t listen.
Have interests outside Medicine
Make sure you have interests outside
Medicine. And go to all parties. You deserve
it and it is a great debriefing for some of the
horrors. Ask for help – there are no silly
questions, except the silly ones.
Enjoy your ‘doctor’ title and the
sometimes painful new respect that goes
with it. It’s all part of the fun. And as you
develop, fun is what it is all about. If you
continually worry, you are in the wrong job.
Good residents are anxious at the right
times, deeply cynical at others. They are
confident as appropriate.
Get that sick sense of humour
Get the resident’s sick sense of humour
as soon as possible. It’s worth writing a
book about.
 SECTION 5: HANDLING SPECIFIC PRODUCTS

This chapter is concerned with selected -Wonder about thrombolysis, Heparin.

common presenting problems and a -Old dunnies conform to no rules.
suggested regime to consider. Remember,
these suggestions are not for the clever-
dick, they are part of the minimisation
routine. There is no compromise in patient

?
management, nor are there any Nobel
Prizes to be won. They are quick
summaries and guidelines – or just jokes;
but which is which?

(I) CHEST PAIN

Categories It’s so hard to pick Classiques from

Most of the time when a dunny is sinks when they conform to no rules
wheeled in, it is fairly obvious which of the
If concerned, don’t be afraid to call the
categories of chest pain it falls into. The
medical registrar or ED consultant.
three types most commonly seen are
It’s better to feel a bit of a dickhead than
Dunny Classiques, Bidets, (almost
find yourself in court. And calling either of
dunnies), and Kitchen Sinks. (Not
these people at crisis time is never treated
dunnies, and DEFINITELY not to be treated
with contempt by any senior staff with an
as a dunny!) Treatment of each group is
iota of decency. When the situation appears
very different. Kitchen Sinks require
clear, which may be after history,
alertness, Classiques a sense of humour
examination or results, refer on.
and Bidets are somewhere in between; the
With true illness, ask, then ask again.)
latter requiring the most usage of grey
matter.
Never, whatever you do in life, treat a sink Bidets
as a dunny Sit back and have a good look and listen
to them. There are clues there somewhere.
Sinks If you panic and treat everyone as serious,
you may as well be a chiropractor.
It is important to be alert to these when
they first come in. Keep an eye out for
them, and if necessary, triage them
yourself. Always be wary of the possible
complications involved in these people. And
don’t stuff around.
You’ll eventually regret under-reacting at
some stage, so always over-react when it
comes to a sink.
Things to consider:
-The history tells you everything. (Mode of
onset, duration, severity, nature, location,
associated symptoms).
-A.B.C. ‘Don’t worry sir, I’ll just put your heart
-repeated ECG, CXR, FBE, U&E, back in place and the chest pain will go
CKMB/CE’s, Clotting, other relevant tests, away
say, RBS, drug levels.
-IV N.saline. If there are any signs of a possible
-Oxygen, GTN, Aspirin, Morphine, etc. Classique, then treat as such. Otherwise,
-Treat arrhythmias as per protocol. send off any appropriate test that may give
-treat complications, such as failure. you a clue. Think about IV Ranitidine, oral
-Urgent angioplasty Mylanta, Amylase, blah, blah, blah. The
past history of a bidet is often a dead
giveaway. Refer in the direction that seems
most suitable. Document your reasoning,
forget about the eventual outcome - you’ve
done the job.
Classiques
Do whatever you like.
(ii) FRACTURED NECK OF
FEMUR
A painful hip in the elderly after a fall is a
fracture. You just have to decide how far
you investigate to find it. With the example
of NOF, external rotation and shortening
are often not present. The best sign is
tenderness over the greater trochanter.
(+ve = stop-thinking sign.) I must qualify
this by saying that with an impacted
(usually) subcapital fracture, tenderness
may be absent. Even considering the
latter, tenderness sought in the right spot is
present. At times, the Greater Trochanter
rule is forgotten, and with poor radiography,
(the accepting resident’s fault), not so
obvious fractures are sent home and
admitted the next day. An admission thus
avoided is an admission better done
yourself. Moronic cleverness - wins no
points with any Wall. Certainly, this may
happen with some impacted sub-capital
fractures where the fracture is difficult to
see.
‘Tis better to have admitted and scanned
than never to have practiced again.
Just ask!
The best way to avoid a lot of missed
diagnoses, in many bony problems, is to
simply grab the X-rays and take them to the
radiologist, or radiographer, (who sees
normal X-Rays all day long), and discuss
the clinical situation with the former, just the
films with the latter. In many cases, this is
immensely helpful.
False pride has no place when it comes to
getting rid of a dunny.
These people are usually appreciative of
the fact that you are prepared to go well out
of your way to seek their opinions, instead
of considering them some resource of
yours, disembodied on the phone.
Radiologists are amazingly approachable,
and excellent teachers; and excellent
drinkers. (See ‘The People Around You.’)
The X-Ray shows a NOF
-CXR will have been done - check it has.
-Do FBE, U&E, relevant tests to the history,
and G&H.
-Cross Match is considered passé by some
hospitals due to speed of matching, but
generally, it is required to have 3-4 units for
a Moore’s, (Sub-capital, high Cervical), 2
units for a DHS, (Low Cervical,
Trochanteric), and an impacted subcapital
may require no units.
-Put in an IV. Operation will inevitably be
delayed and fluid replacement needed
because of the fracture or through being nil
orally.
-Watch the need for analgesia. A small
dose of Morphine is always needed.
-If pain or displacement is significant,
skin/boot traction can prove very helpful.
Do not listen to anyone who tells you it
can’t be done in the ED.
A small dose of Morphine is always
needed – give some to the patient too
Pain relief without drugs, in the elderly,
is even more important than someone
having to walk upstairs for the equipment.
-Always be on the lookout for associated
injuries; things such as Colles fractures are
relatively common. It can really give
everyone the shits to take a dunny to
theatre twice - it’s not the theatre time, it’s
all the pre and post mucking around. The
Orthopods rarely, (never?), miss associated
fractures.
-before even having seen the NOF, start
working out placement.
-Despite what the clever dicks say, it’s
rarely worth the effort looking for an
underlying cause for the NOF. You’re much
better off sitting on the toilet hiding. If the
history is suggestive, sure, be a hero - but
otherwise, what are you going to do if you
find something?
And.....
Once all done correctly, slag off to the
happy recipient.
(III) BACK PAIN
A horrible quagmire of dregs with very
few exceptions - but those exceptions exist
and it is paramount that they not be missed.
Make no mistake. But recognising them is
one of the most difficult aspects of your job.
Don’t get taken in by their stories; look for a
normal examination and don’t let them get
you down. Certainly, the range of
presentations and the implied severity can
make decisions by the tyro impossible.
The golden rule is: if in doubt, treat as
bogus.
It’s not heartless if you do it right.
Consider this: If they were faking, you most
likely won’t see them again. If they were fair
dinkum, they will be back - and what harm
has been done? They’ve usually had the
pain for years. The more significant the
pathology, the quicker they’ll be back. Look
on it as a very effective diagnostic tool.
With (recent) neurological signs, admission
is more likely to be necessary. And now
such admission presents its own problems,
especially getting someone to accept the
patient. (= Hypotoiletospinal indicators.)
If admission does not appear obviously
necessary, there are many factors to
consider to decide if it is a case of Bogus
Back or Dinkum Back.
Spinal Toilet Indicators
First of all, it is necessary to take an
adequate spinal history. This should include
all vertebral dunny determinants, better
known in academic circles as the Spinal
Toilet Indicators, or STI’s. Ask about
previous episodes of back pain. Has it been
every day for the last 20 years? The dunny
may think this is very impressive; you know
better. What about aggravating and
relieving factors? Is it worsened by the
thought of an honest day’s work? To not be
able to work at all is scarcely a genuine
person.
‘My moccies are broken….oh, and my
back hurts. Again’.
. Does the pain worsen when one’s
favourite pair of moccasins wear out, or
when a relative dies? (Classically, they can
remember when the moccies bit the dust,
but not the relatives.) Is the pain relieved by
a certain amount of time off work?
The pain. Oh, the pain
What about radiation of the pain? Does
it radiate to any part of the body that the
doctor suggests? Does it in fact radiate to
other people or nearby objects when really
bad? What about the type of pain. Is it like
the pain they get when kicked in the head
at the pub? Or more like the gut-ache they
get at times, and ‘the needle ‘ gets rid of?
Are they stupid annoying bastards with
nothing better to do?
The examination
An educated and detailed examination
usually confirms your thoughts as
suggested by the history. The findings are
usually of two types in a doubtful case:
- The type of patient whose power and
sensation in the lower limbs are impaired in
a bizarre manner, but oddly, reflexes and
any objective signs are completely normal.
Straight leg raising is painful but without
sciatic nerve stretch. They watch the
doctor, waiting for clues as to when they
are supposed to get the pain. Despite
intensive studies, no one has been able to
find out how lumbar disc prolapses
produces these patterns of pain. These are
Spinal Toilets.
- Or the neurological pattern conforms to
somewhere near anatomical, in a patient
that appears to be a real nut. There is
usually minor sensory, power or even
reflex changes, with consistent positive
straight leg raising sign. It’s amazing how
often these patients present with a
mechanical problem, and on correction,
the personality problems tend to
disappear. It’s more like they have a lower
pain threshold than most people, but not
ridiculously low like a toilet. These are
Spinal Bidets.
The term ‘Spina Bifida’ is a
transmogrification of ‘Spinal Bidet’ first
occurring in ancient Greece when the
early physicians bothered to roll the
patient over.)
Investigations
Investigations are very limited. Recent
Lumbosacral X-rays will probably have
already been done. If not, do them,
knowing they will show ‘minor degenerative
changes.’ Give no indication to the patient
as to your opinion of their pain, at least until
you have seen the films.
The Greeks first rolled patients over –
we can’t be bothered now; you find
things…
If you give them full Bogus Back
treatment, and then see on X-ray a marked
spondylolisthesis, (grading such, as with
most similar things, is completely useless to
the A.O.), well, it’s a trifle embarrassing. If
very good clinical signs, consider a CT. An
MRI is the ultimate decider, but the costs
and availability rule it out for anyone you
are going to be seeing! Will this change in
future similar to C.T.’s? They were priceless
and consultant ordered only, a few years
ago.) In those appearing in significant pain,
an ESR, CRP and FBE can sometimes be
very helpful. Especially in the elderly, or
those with other organic disease. In that
case, order the associated tests for that
disease. And think of other organ systems
and referred pain as appropriate.
What now, my hate?
For a Toilet, it’s out the door with
minimal treatment and interest. With a
Bidet claiming to be in severe pain, try the
range of non-interventionist things that you
have handy at that time. This will include
the whole gamete of analgesics and their
various forms, muscle relaxants, NSAID’s,
physiotherapy, the LMO, (the bastard sent
them to you!), Outpatients, those ‘wonderful
chiropractors’, (if they are that type of
patient), treat the other systemic illness or
do the hard thing - the correct treatment
that is the only true treatment - sit them
down and tell them how pathetic they are
and this is not the place for them. This
usually takes too long for us to do, and the
reaction is ferocious. (Now where did all
that energy come from?) But a good talking
to is honestly, what they need.
What they get, is what the system provides.
It is a bit sad for both doctor and patient.
Pork Chops and Running Away
If the Toilet is carrying on like a pork
chop, and you’re thinking there might be
some mechanical problem present, you
may have to call a registrar for help.
Neuorsurgical registrar looking for the
AO that sloughed him a Spinal Toilet
But no one with any experience wants to
know these dunnies. Usually, the first port
of call would be a Neurosurgical Registrar,
if available. Next an Orthopaedic Registrar -
but don’t expect much joy - most will have
been told by their bosses to refuse these
people - especially work related problems;
their claims are never approved, and they
never pay their bills. Try to sell them to
others if you can make a good bullshit case
for referred pain, or systemic illness.
You must be firm with a Spinal Toilet, but if
a registrar has been called, run away from
the ED for a while. A long while.
(iv) CVA/TIA
My goodness, these can be boring! And
my goodness, these can be rewarding!
There are varying degrees of severity from
the deeply unconscious, to minimal
localised weakness. Treatment follows
along the lines of assessment, protocols
and specific situations. The cause
obviously has to be established through
pathology and C.T., but I purposely avoid
specifics because each case seems to be
unique, or easy. One for learning in the
workplace.
Vegies
If comatose and elderly, obviously
having lost most of their cortex, it’s in
everyone’s interest to insert a token IV,
attach some O2, and rapidly admit to the
ward to die. Talk to the rellies.
One of the few times relatives are sensible,
and the patient is co-operative.
Fruit - near vegies
A Fruit has hard, classical neurological
signs and is mostly conscious. Admit them
to hospital, of course, but possibly not
yours. (See Thrustopelves) There, they
can be assessed and treated, but while with
you, you are bound to send of a large
variety of tests to try and establish the
cause - especially if young. This can
include almost everything, but now with CT
readily available, this will be likely to give
you the answer. (usually.) Appropriate
treatment, (transfer, heparin, hypotensives,
antibiotics etc.) can then begin.
Fruit are sort of close to being veges
Remember prompt treatment in the first 2
hours of a CVA occurring.....ummmm.......
usually makes no bloody difference
whatsoever!
Take-aways; no-where near
vegies
The term Take-aways is sometimes
used for Outpatients, or patient transfers -
this is incorrect usage in the classical
sense. In our context, it means minimal
signs and symptoms. The silly meaning
stems from the contrast between unhealthy
fast foods and vegetables. Isn’t that clever?
Anyway, they are showing minimal signs
and mostly don’t need admission. They
need a good examination, maybe some
investigations, and appropriate treatment
for hypertension, emboli, stress etc. May
need home help, physio, nursing care, LMO
care or an institution.
(v) SIGNIFICANT FRACTURES –
How?
Full details of how the injury occurred is
vital.
The mechanism involved, and the
energy of impact should both be quite clear
to you after talking to patient, relatives,
ambos, police, even the other cars’
occupants.
Be very anxious about a high-energy
impact, and carefully look for other injuries -
spinal, lungs, spleen.
Decide early if there is any possibility of
the fracture being compound or there are
neurovascular complications. It’s very hard
to heave an ischaemic foot back into place
without proper analgesia, but you just might
save it.
LOOK at the X-Rays
Examine the X-Ray closely.
If an intern sees pathology on an x-ray, it’s
not there.
Have it clearly in your mind, or even
better, in front of you when you are
describing it over the phone. You are not
expected to come up with clever
classifications, but you should be clear on
bony anatomy. Describing over the phone
is an art, which will come, and is expected
by the registrar - despite the fact that they
are occasionally lacking in this art, but they
can bullshit. A poor description is very
frustrating for both people. Ask the ED
registrar to describe it to you.
Interns! 1ml of subcutaneous local, and
outpatients appointment is not quite the
best treatment for shaft fractures
Treatment
Immobilise the fracture with anything
you can get your hands on. Blankets,
sandbags, splints, wood, newspapers,
slings, tape, traction, anything! Try to avoid
plaster early if you can, because a good
registrar will only trust his own eyes when it
comes to looking at the skin around a
fracture site. Use Morphine and Maxalon
for analgesia, IV only, and quick volume
replacement as appropriate - then add a
litre! Order baseline tests. Investigate and
treat the other injuries. Anti-tetanus and
antibiotics as needed. (Flucloxacillin and
Penicillin.) Later, get BAC. So often these
patients are bikies or such, (and been in
many times before,) so look around for any
of their decerebrate mates before voicing
your opinions.
So many shaft fractures occur in bikies,
you’d better watch what you say
(vi) P.V. BLEEDING
Blood in the Undies
If there’s one thing that I despise, (and
so does every other honest doctor - male or
female,) is Obstetrics and Gynaecology.
(Well, at work.) It is just so personal and
intense, you’d be crazy to say, ‘Oh good! A
threatened abort is coming in! What a
rewarding and interesting patient this will
be!’ I have been told that the diagnosis
often rests on a well-inquired history. I
wouldn’t know. I just hear ‘Red sails in the
sunset’, and pick up the phone. I refuse to
accept this attitude is sexist. It is not. It’s
gonadist. If the sexes equipment was
reversed, I’d still hate it; it’s the fear of the
hidden, the unknown, the mystical.
Orthopaedics, it aint.
It is apparently necessary to get details on:
-dates
-contraception
-past medical, gynae, obs history
-pain, bleeding, discharge
-other systems
-and a very detailed history of intercourse;
while not being particularly important, one
can learn a hell of a lot and try it out later at
home. And you can keep up with the latest
trend in frequency, so that you and your
partner can decide if you are currently
prudes or animals.
AO gets an exciting intercourse history
and decides to pump up his partner that
night
On the whole....
Examination requirements expected of
the AO varies a lot. Certainly, feel the belly -
it’s easy, well lit, and pleasantly scented,
and looks like you are doing something.
PV’s and speculum exams are on the
whole (?), not necessary.
Interns! Only do PV’s on women.
This woman (they are usually women,
apparently) has probably had one from her
LMO already, and is going to get one of
many from the gynae’s in a minute, so why
on earth should you subject her to another
one, in the humiliating, fenestrated ED
situation.
The gynae’s always ask what the PV
showed. Don’t worry, be strong and explain
your thoughts as above. You will be
supported by just about everyone. And this
doesn’t even take into account the cases
where PV can be extremely harmful. (Such
as cervical shock, placenta praevia etc.)
More for you, is to make sure an IV is in,
appropriate fluid and analgesia has been
given, group and hold, FBE and beta HCG
has been done. Most are the various first
trimester aborts that one sees. Refer for
scrape.
A scrape may be needed
(vii) CCF (viii) OVERDOSES

Failure to admit is no failure Self-snuff success, never

Any degree of heart failure short of APO is There are two schools of thought when
never a definite indication for admission. it comes to OD’s. Either they give you the
CCF does not occur suddenly. APO is a shits, or they REALLY give you the shits!
figment of some boring physician’s
imagination. (Is that a waste of an
adjective?) It is a gradual progression, with
sometimes a large change suddenly. Some
degree of correction will, therefore, revert
them back to their coping level. So, in a
nutshell:
-pure CCF patients are usually nice old
ladies if so, don’t treat them like a patient!
-take a full history and reasonable
examination, then get onto the important
stuff: where are they going?

Excretion The AO selects an instrument to assess

Assess the family before the patient. an Overdose Dunny
The usual suicide gestures and attempts
are performed by people who are virtually
all born losers.
(The same people who wear tracksuits to
hospital, always smoke, and when their
houses burn down, they always make
themselves available for TV interviews.)
They are either too stupid to do it properly,
or they are devout attention-seekers. Those
who choose to self-snuff, and are fair
dinkum, do so after much thought, and they
do it properly. Here, I choose to ignore this
Always assess the family first – you latter group; it’s a little too late for our
might get some clues where granny has involvement.
been
Assess the situation at home, re Reciprocal Suicide
husband/wife and his/her health, support I will now explain some of the principles
network, and patient’s attitude to these. of the ODD, (Overdose Dunny) theory of
What is the degree of physical impairment Reciprocal Suicide.
in his/her daily life? How well have they
coped in the past? (I mean, creeps to the
midzones and 20 metres of exercise
tolerance may be normal. A loss of fluid via
some IV Lasix may be all that is necessary
to avoid an admission. And with regard to
investigations, it varies between nothing,
and everything. (FBE, U&E, RBS, CE’S,
ABG’S, CXR, ECG, CRP, ESR, etc.) It
depends a lot on what your instincts tell
you, or if you actually feel some care for
them. This has been known to occur
occasionally with lovely old ladies. But all
too often, there is associated COAD. These
are usually stupid men; but stupidity knows
no boundaries. Obviously, you need to put
it all together to ascertain their coping level.
Then excrete in the appropriate direction.
 ODD’s are a cross all AO’s must bear; - Watch out for a doctor called ‘Admitting
but good AO’s know a Joseph of officer’! They are bastards, well and truly.
Arimethea or two… - When you do get home from the ED,
settle down with a few beers, and have a
Reciprocal Suicide is where the AO has
chuckle about the pleasant day you’ve had.
had a gutful of this type of person, and
Life is full of wonderful memories!
decides to do himself in - but he usually
The actual treatment of ODD’s varies
chooses alcohol as his poison, and it takes
with the means. The nature of the drug
a fairly long time to do it.
decides where your emphasis will be, but
Here’s just a few of the principles that
all systems are watched. This means that in
are the guidelines for ODD’s: (you will often
terms of routines, it is fairly simple. Get
find more of your own.)
some sort of history from friends, relatives
- always take your OD near a handy phone,
or ambo’s. Were any drugs found near the
or in the lounge room surrounded by friends
patients? Make sure you can get the
and family - or even better, just outside the
patient to say they still want to kill
ED you regularly attend for ‘terminal’ care.
themselves, to make psychiatric admission
- Never take any drug that in any dosage
more straightforward if it is necessary.
could cause accidental death, later
When examining, do a good neurological.
complications, or tastes yucky. You have
These days, there is much less of a
your standards!
tendency to empty the stomach. The
- Yell loudly and persistently about wanting
circumstances are rare, so if any doubt,
to kill yourself while in the ED; this is a
don’t. Even age-old Ipecac is considered
good thing to do, as the nurses will take
passé now.
away any dangerous tools or objects
around you - hell! You don’t want to hurt
yourself!
- Be careful when faking unconsciousness.
Although this can give you a real buzz, if
you don’t ‘wake up’ in time, those bastard
doctors will pump your stomach, press on
your nails and chest, or squish some of
your naughty bits.
- Say ‘fuck’ and ‘shit’ a lot. Let them know
someone important is in the ED!
- Choose your hospital carefully, and keep
your timing precise. You wouldn’t want to The queen mother was a cokehead who
find a doctor who would try to help you, and often had gastric lavage
you don’t want to get the same doctor each Charcoal is often a good idea. And don’t
week you suicide! forget they, ummm, enjoy being sworn at,
- When vomiting in the ED, be sure to pinched and cajoled - you must reinforce in
never get any of it in the bucket provided. their tiny minds that this behaviour causes
Walls, floors, curtains, nurses, doctors, all sorts of unpleasantness for themselves,
other patients etc. are much more fun! Vary as well as you. Occasionally, intubation and
your game! lavage is appropriate.

Antidotes
Look up the books for appropriate
treatment of particular drugs. But a few
pointers are necessary. Benzo’s can just be
slept off. Flumazenil is too expensive to
waste on these people - they are just going
to do it again. Paracetamol is an enormous
worry. You see, they think that this drug fits
the principles of Safe Suicide - i.e., it can’t
hurt you in your ‘suicide’ - so they take
heaps, not realising the dangers. Always
let them know about the horrors of a dying
The AO checks response to auditory liver, and watch them go pale as hey realise
stimuli they may actually have succeeded in their
bullshit quest. Having a pull
The suicidal patient is terrified of death.
Once the diagnosis is clear be very
Follow the guidelines for N-Acetyl-
careful to exclude a posterior dislocation.
Cysteine: they are simple and clear. The
Suspect posterior in loonies, epileptics or
investigations are obvious; be wary of
unusual stories.
unexpected drugs taken at the same time;
In dislocations, like 50% of the
keep a sense of humour and have some
population, some drugs and a pull are
fun. Personally, they give me the shits.....
needed.

(ix) DISLOCATIONS

Legal x-rays
These are usually rewarding, simple
problems that can make you forget the
previous run of dunnies you’ve had just
prior. (Though at times, they can be a pain
in the arse.) With the shoulder, the patient
is usually a young male, perhaps with
recurrent anterior dislocations following
trivial injuries. (Recurrence is getting much
less common with the improvement in ED
reduction techniques and absence of tissue Tell the nurse that drugs & a pull are
trauma caused in the past by inexperience needed
and inadequate drug treatment.) Always
remember to check for neurovascular After IV analgesia and Benzo’s - usually
complications. (So often forgotten.) Fentanyl (1-1.5 mcg/kg) and Midazolam
(0.1mg/kg) - Kocher’s is the best pull. If
done properly, it is much better than the
Hippocratic. Usually it pops straight back in
with minimal effort.
Difficulties sometimes occur with the first
dislocation, if it’s actually old, or it’s a
missed posterior dislocation. In some of
these cases, and especially after two or
three decent pulls, a GA may be necessary.
But only very rarely. (Some surgeons, in the
past, advocated reducing all first
dislocations under GA, but this is no longer
the case.)
Once reduced, make sure it stays that way
If an Intern sees pathology on an x-ray, yourself. Hold it until a suitable arm-binder
it’s not there. If two see it, then send the is found.
patient home.
Even in the most obvious cases, one
should attempt to get a pre-reduction X-
Ray. (One needs to know exactly what you
are dealing with before you go pulling it -
good advice for a number of situations.) It’s
not that you are worried about the dunny,
it’s just the annoying legalities.
When you think about it, almost all the X-
Rays done in the Emergency Department
are done purely for legal reasons.
Excluding orthopaedics, how often do
they change your management, or alter
your clinical suspicions?)
Suitable public patient arm-binder
Then X-ray it to make sure all is well.
Most minor fractures will reduce with the a bit, so that the slough is definitely
dislocation, so don’t get too worried about successful.
those - just check the films.

Patellae
Dislocated patellae are usually young
girls who scream the place down. The
lateral dislocation is obvious - some claim
it’s gone medially, but this is only because
the medial femoral condyle has become
more obvious. If you’re a real prick, you
could quickly shove it back immediately.
But it’s best to use Fentanyl and
Midazolam. Hyperextend the knee and your
partner shoves it back medially. Put it in a This bloke could do with a psych referral
back slab or cylinder, and refer off for – or you could ask him out…..
opinion on possible lateral release.
(XIII) FOREIGN BODIES
(x) COLLAPSE
Fun for the whole family
Lead Injections If you think loonies sound like fun, you
Don’t you just feel like shooting these aint seen nothing yet. Foreign bodies are
bastards, or at least the do-gooders that led the source of a lot of bullshit stories, but
them to you? There’s never anything wrong many more true ones. I can honestly
with them! Well, perhaps not never - but confirm this. My very first patient as an
next time you see a patient is nothing else, Intern was a 15 year old boy who rammed
just ‘collapse’, just recall later what was his mum’s vibrator up his arse so far, it
wrong with them, what you found. Bloody ended up in his Transverse Colon. And the
nothing, I’ll bet. Shoot them. batteries didn’t stop for 24 hours, leaving
Treat the usual causes, but with a collapse him with a constant mid abdo wriggling, like
where no pathology appears, the problem an embarrassing subcutaneous snake. He
is purely social. needed laparotomy and colostomy
And is that why you’re there? No! But even -temporarily. So they are no joke….Crap!
so, does it hurt to have a friendly chat about FB’s are hilarious!
their troubles? Then piss them off! Identify them then ask experienced
people for advice. Removal depends on
how far up and what they are. Ingenuity is
(XI) PNEUMONIA/ASTHMA
your friend. But try to stop laughing.
In a nutshell, after path and CXR etc:
Nebs; possibly continuous.
Oral Prednisolone (1mg/kg)
Antibiotics
IV Hydrocortisone (3mg/kg)
IV Salbutamol (4-5mcg/kg-use protocol)
Intubate
ICC if needed
At some time, perhaps before intubation,
ask them to put out their fucking cigarette.

(xii) LOONIES

History
Get an extensive history. Not because
it’s of any medical benefit, it’s just that it
may be the only laugh you’ll get all day.
Write some fascinating notes or
certifications and refer off. If the story
doesn’t sound all that impressive, jazz it up
Some FB removals are more fun than
others
By the way, the surgeon on the above
kid, wiped the shit of the vibrator and
handed it back to mum.
 SECTION 6: THE PEOPLE AROUND YOU
(I) NURSING STAFF
The Old Attitude
Nursing staff are there to help you. Keep
telling yourself this. Even try to believe it.
But if you do, you obviously aren’t an
Intern. Nursing supervisors are no longer
the dragons they once were. Nursing
Administrators are much improved in that
responsibility is far more likely handled by
the ward manager. And the general nursing
staff have always been pretty good. But the
old attitude remains with some of the older
nurses, and they have indoctrinated a few
of the younger ones. And it is the lowest in
the food chain that cops it – guess who?
The golden 2-gilled intern; lowest in the
food chain
Old school nurses have a strict code of
behaviour, based on jealousy and the
dangers of a little knowledge but no
responsibility.
They drum it into the younger nurses,
and expect the latter to follow it to the letter,
as they do. Eventually, in the gullible, they
manage to erode the fair nurse’s qualities
of friendliness, fun and common sense.
Inevitably, therefore, three groups of nurses
become obvious: those completely
indoctrinated by the old farts, those
wavering, and the true blues, who despise
these old bags as much as the old bags are
infuriated by their charges youth and vigour.
I should add that all these generalisations
ignore the fact that half the doctors
encountered by nursing staff are total
arseholes.
Multi-directional antagonism
What exactly are these policies of
hatred? As with dunnies, there are a
number of principles involved. These, when
grouped together, are known as Multi-
directional antagonism. I.e. whatever the
doctor says, nursing policy is the opposite.
In order to illustrate exactly what I mean by
this, please allow me to quote from an
official guide book once shown to me: ‘No
brains or principles - the old-fashioned
nurses’ book of rules’.
Rule I - On arrival of the patient in the
Emergency Department, never try to
dissuade them from coming in. Immediately
give them a bed, make them comfortable,
and tell then that the doctor will be here
soon to ADMIT them. (Their capitals.)
Rule II - It is vital that the AO is let known
that the patient has arrived as soon as
possible. Do this before deciding yourself,
or making the least inquiries, as to whether
the patient should be somewhere else. It is
not your job to think, or be of assistance.
I.e. ACCEPT NO RESPONSIBILITY.
Rule III - When calling the AO, take no
notice if he tells you he is not to be
disturbed, while he has ten minutes off for
lunch. He is paid enormous amounts of
money to be there all the time and have no
private life. (He is paid almost as much as
an infection control nurse, so make him
earn it!) Note that these principles do not
apply to nurses of any rank - OUR breaks
are frequent and sacred.
Rule IV - When the AO arrives to see the
patient, tell him what YOU think is wrong
with the patient, and what you think should
be done. There is no harm in this, as they
need help, and when you are wrong, who
cares, as you ACCEPT NO
RESPONSIBILITY; and if you are right,
you can take great delight in making him
look stupid or unnecessary.
Rule V - If, during the course of his
examination, the doctor asks you to
perform any simple task, such as passing
him an instrument, always correct any
incorrect grammar or pronunciation, and
remind him repeatedly of basic courtesies,
no matter how busy he may be. Life and
death decisions, for which he is solely
responsible, do not excuse bad manners.
And be firm with them here - they are there
to be taught.
Rule VI - If the doctor leaves the patient
for any length of time, quickly go to the
patient and point out to them where the
doctor is wrong, the correct way you would
do things, and how certain personal
problems, (and detail these) are affecting
the doctor’s judgement.
still see it occasionally, and I shudder to
think what is being taught to nurses doing
degrees in ‘University’ courses by jealous
lezzo nursing teachers, as these students
know nothing of nursing and are taught to
be doctors, but without the hard work or
responsibility. Hospital trained nurses are
infinitely better.

Rule VII - Should the doctor require any

sort of investigation, do NOT help by filling
in details on forms or taking blood etc. This
is a non-nursing duty, and is more
appropriately done by the doctor, than one
of five or six nurses standing around
chatting. (The latter HAS been approved as
a nursing duty.)

Rule VIII - Before any results are back, Lezzo teacher of nursing university
repetitively ask the doctor what is course
happening with the patient. If YOU have
decided they should be admitted, let the
doctor know. i.e. Don’t ask whether the
The Secret
patient is to be admitted or not, just which The secret to getting along with all good
ward they are going to. If the doctor nurses, is to just do what you are told.
suggests the patient is going home, against You will work together well, both learn
YOUR judgement, look very surprised, and and the patient gets the best possible
call the nursing supervisor so that she can treatment. MDA nurses never realise that
wake up and come down and look their attitudes lead to their advice NEVER
surprised too. Then you can both ask the being sought, and so they hate us more!
doctor if he/she IS SURE THAT THE
PATIENT IS GOING HOME. Follow up by (ii) RELATIVES
repeating this. Do not stop until they are
obviously angry. Then ask again. The REAL enemy
The innate dunnyism exhibited by the
Rule IX - Once treatment has been
patient pales into insignificance when
decided upon and instigated, question all
compared to the conniving, sneaky, and
prescribed drugs and dosages.
annoying tricks and attitudes common to
the truly detestable - relatives.
Rule X - At the end of your shift, on your
They thrive on rudeness to us, are never
way home, give the doctor your own
appreciative, and blame us for all the faults
appraisal of his/her performance. When he
in the system. Yet they are never prepared
is still there the next morning when you
to get insurance, and put their money
come back, do not put up with any lapse in
where their overfed mouths are. They
their manners or neatness. Otherwise, they
attempt to counter your every move. Any
may expect basic understanding!
suggestion you make will be negated; any
treatment instigated will be deemed
Rule XI - Do not talk to nurses who
ineffective. They question your diagnosis if
fraternise with doctors. They are whores
it is not as serious as what they have in
and she-devils. And it’s not that you are
mind - as if these morons have a fucking
jealous, it’s just that you are....fussy.
clue! Why are they so DISAPPOINTED if
granny does not have a serious illness?
What chance do we have against such
Because they have only one thing on their
indoctrination? With these attitudes being
minds - getting Gramps into hospital, as the
drummed into younger nurses, the choice
airline tickets to Queensland are non-
must lie between rebellion and capitulation.
refundable, the newspapers cancelled, and
Again I emphasise that MDA is dying. But I
they are determined to make their
responsibilities yours.
Why does Granny need admission? The
rellies airline tickets are not refundable
Be nice to rellies
The number one rule with rellies is to be
nice to them as long as possible - even
though they are real arseholes - as you
may need them to take gramps home with
them. This is Hippocratic Hypocrisy.
Examine Alone
It is far referable to see the patient by
themselves.
Politely ask the enemy to wait outside.
Give them a smile. A knowledgeable grin.
(If it’s a real dunny you can snarl at them
later.) And don’t put up with their stupid,
pony-tailed kiddies wandering around
yelling and being completely ignorant.
Cheerfully ask Mum to perhaps take them
outside. No good? Urge mother to remove
them. Still no good? Take action. Assess
whether they are old enough to speak. If
not, look left and right, then give them a
hard swift kick up the arse. If they can
speak, try to look very busy, then
accidentally knock them over. Be careful
with the latter, just in case you actually
cause an injury - if this does happen, an
intern is required to see this patient. Being
alone avoids the relly answering questions
for the patient. This is infuriating and gives
the wrong idea of the illness. The nagging
wife can come back later, and this
interaction helps to give you an insight into
the dynamics of their ‘relationship’, and the
cause of his peptic ulcer. Rellies are also
distracting staring at you, sighing, looking at
their watches, or just their whole miserable
presence. How rare, the pleasant relative
keen to take gramps home. They take you
by such surprise, you find yourself back
peddling from your usual rude approach.
Loves Masturbating Often
How often does it happen that the rellies
bring gramps in, and proudly announce,
with a ‘stuff-you-smartarse’ nature: ‘Now
you have to take gramps, as our local
doctor has arranged the admission.’ All he
did was slough the patient to you! They’ve
got a positive suitcase sign, jarmees,
toothbrush, and nightie - the problem is that
you have now decided 100% that
GRAMPS IS GOING FUCKING HOME!
You tell the rellies this and they are
distinctly unimpressed. (Perhaps you
should leave off the ‘fuck’). Chat quietly to
them in bullshit mode. Sound very sincere.
Use one of your old favourites in this
situation. Perhaps one of the old impalers
like:
‘I’d love to admit gramps, but there’s only
one adult bed in the hospital, and I’m
waiting for a young child and his
breastfeeding mother who have been in a
bad car accident and are dangerously
injured, and has a relative who is a nun
coming in with them.’
This highlights an important principle -
Relative Dunnyism. The double meaning
is obvious. The relatives do not perceive
gramps to be a dunny, either on purpose or
honestly, but compared to this sick child,
they can see that he probably is a bit of a
ratbag.
A Typical Case
When discussing the patient with relatives,
be very careful not to express your true
thoughts on the situation.
Factual Thoughts are obviously OK, but
when it comes to the possible involvement
of your superiors, Factual Facts are NOT to
enter the discussion.
Rellies, of course, are vaguely human,
and will respond better to pleasantries and
bullshit than the nasty truth. An example:
- I’d love to take gramps home with me.
(I’d love to shove a sock down his
pathetic throat.)
- He’s such a cutesie-wootsie.
(What a disgusting old fart.)
- He’d love my house.
(I’d hire a pit bull terrier for the night.)
- But unfortunately.....
(Thank bloody God...)
- I already have three elderly people from
last night’s shift staying with me.
(I hope I get a bit tonight.)
- I don’t suppose he could stay with you?
 (If you don’t take him, he gets wrapped
in a sheet and sent down the laundry
chute.)
- Thanks for that....
(Why don’t you just piss off with him
now, misery guts?)
- Goodbye.
(Fuck off.)
(iii) INTERNS
Have fun
You can have a lot of fun with ‘terns.
They expect you to know just about
everything, and they find it very unnerving
when you say, ‘Gee! I dunno!’ This really
pulls the rug out from underneath them!
How interns should see registrars
We don’t like to have our ‘terns upset,
so most of the time we BULLSHIT them!
Absolutely Crapulous
It is quite safe to tell them absolute crap,
as no matter what happens, it’s their name
in the notes. No matter what the outcome is
to the patient, with treatment formed on
your advice, let him/her cop the flack. They
are too new to fight back. They may feel
they misheard or misunderstood what you
said. And who gives a shit? Why not tell
them the first thing that comes into your
head when asked a question. This saves a
lot of time, and can have hilarious results!
(Don’t forget, if anything nasty comes of it,
just deny you ever said such a thing.
Sorry guys, you’ll get your turn next year!
(iv) MEDICAL STUDENTS
See ‘Interns’, but change ‘hilarious’ to
mildly amusing.
(v) AMBULANCE DRIVERS
Rewarding
When the patient-cum-dunny is wheeled
in, it can be very rewarding to have a short
chat to the ambos. They are actually quite
good at ascertaining dunny status, perhaps
not surprisingly so, as they see the home
environment - moccies, filth, and flying
ducks on the wall. Don’t take as gospel the
information offered by the ambo. It is
certainly good, but your treatment depends
on your view of the situation. (Even so,
ambo’s views are brilliant compared to the
patients’ friends/relatives.)
MVA’s
In the case of road traffic accidents, an
ambo’s description of the speed/impact
energy/ mechanisms involved is vital and
excellent. Actual terms used can vary from
a ‘rear ended RTA at relative impact of
80km/h’, to ‘mate, those two cars are
rooted’; and both phrases convey the
seriousness of the accident to you in their
own way.
Snobby AO’s miss much information.
Piss-pots
But, of course, the best reason to chat
to ambos is that they are a rather pleasant
bunch of degenerates and piss-pots, well
worth knowing. They often know of
excellent parties and functions to which an
invitation may be forthcoming. Also, their
job is very stressful and they may need to
chat themselves. And it never hurts to tell
them what happened to previous patients
they brought in, or just do a little tutoring -
they deserve it. (A good way for young
residents to get into the habit of teaching
others.) Everyone benefits.
(vi) RADIOGRAPHERS
Get On Good Terms
In an area of the hospital, such as ED,
where X-Rays constantly being ordered, life
is so much easier if you make an attempt to
get along well with the radiographers.
Medical or surgical cases all end up
requiring single, mega, or medico-legal X-
Rays; and if you’re on good terms with the
picture-takers, it will make your job a hell of
a lot easier.
Helpful Opinions
Radiographers, (unfairly), take a long
time to convince you’re not a smart-arse -
usually because of arrogant, blow-in
registrars, with whom they’ve had bad run-
ins. But once convinced, they are very
helpful when X-Rays show fractures that
are difficult to assess. This can be
especially helpful when you are busy.
These people look at X-Rays all day long.
They know what normal is. So, sometimes,
they are able to pick fractures, which may
otherwise have been missed. Of course,
you must just consider their opinion, and
form your own - but it’s interesting how their
view sometimes changes the type of
treatment which was about to be initiated
by the busy AO!
Just ask them what they think.
Ebbs and Plebs
You are rarely too busy to take the films
back to the X-Ray department and ask the
radiographer what he/she thinks of such
and such. If you are by yourself at 4am with
a Cervical spine film, every little bit helps.
But yet another good reason to get into
the habit of wandering off to X-Ray is to see
your dunny in a different environment.
At times, a patient such as a back pain
pleb may have overwhelming pain in the
ED. Yet when being transferred, moved and
photographed in the X-Ray Department, (?
XD) this overwhelming pain seems to have
ebbed somewhat!
Check the dunny in X-ray
This can be very pleasing when you get
back to the ED and take great delight in
slagging them off - and they will probably
never know how you found them out; or,
they will be sure you are a real bastard, and
next time, go somewhere else!
No Worries
And view the X-Rays as they appear. In
this way, a number of opinions from
radiologists or radiographers can be
sought. Thereby, any doubts in the ED you
may have had, may be resolved without
unnecessary worries, and questioning looks
from rellies/patients/staff can be avoided.
(When you look like you don’t have a clue!)
Don’t ask for pseudo-clever views
unless you really know what you are
looking at.
Ask for pictures of specific areas, or
common, accepted extra views such as
carpal tunnel or skyline patella -that’s OK.
Discussion with the radiographer as to the
possible benefits of something like an
oblique view of the fracture is far more
rewarding than just ordering them. And their
suggestions can be very enlightening.
Finally, radiographers are also good to
know, as they are friendly like ambos, but
much less degenerate. Publicly. Get to
know them.
(v) CONSULTANTS
Your Own Boss
One of the most fortunate aspects of the
ED, as compared to other departments, is
that one is rarely under pressure from
consultants. Modern ED’s, of course, now
have their own specialists, who wander
around offering advice, but they are often
tied up in administrative functions. Thus
you tend to be your own boss. ED
Consultants are generally good value and
should be asked for help whenever needed,
plus advised of any pending crook patients
due to soon arrive. Good EDC’s see
patients when busy, do procedures when
the AO is inexperienced or tied up, and
supervise RMO’s if AO’s are pre-occupied
with a resuscitation patient. Most are very
good and lack the usual consultant’s
arrogance. But a bad one is big trouble.
And never forget that they are Consultants,
who have done the hard yards, and should
be treated with respect - this is sometimes
a problem with friendly, young consultants.
Fun and co-operation is vital, but make
sure you occasionally emphasise the
respect issue in front of the residents, so
that they are trained properly in this regard.
Never lose the AO/young EDC relationship,
though. It’s a big factor in our learning.
Bullshit
From here on, I refer to non-ED
consultants only, with one mention - be
careful when bullshitting EDC’s. Do this
only to save your skin, and only in small
matters - the registrar/consultant
relationship is much ‘closer’ than other
teams. Anyway, there is a certain amount
of contact with other consultants. This
requires a more specialised form of
balderdash. And what a strange group they
are!
To avoid coming in to the hospital,
consultants are the only group in the
hospital who actually want to hear bullshit.
What I mean here is, when you ring
them up about a patient directly, (because
of health insurance, registrar on the nest, or
slow registrar,) they ask all the appropriate
questions about the patient’s condition, but
one soon learns what they don’t want to
hear. They do not want to get responses
from you that means they have to actually
come in. They prefer equivocal findings to
be presented as ‘negative’. So, unless the
patient is crook, it’s best to calmly and
laughingly answer ‘goodness, no...no....no!’
There is no need to upset their barby just
on the whims of a moderately ill patient.
Hell - if they want to hear it, give it to them!
An Example
Imagine the situation. You’ve got
someone with abdominal pain, and you’re
just not sure what is going on. The surgical
registrar has gone round to the Surgeon’s
house and has just finished his/her third
bottle of Chardonnay, and perhaps is
lighting up a joint.
Surgical registrars smoke a lot of dope
He is of little aid to you for advice. But it
doesn’t matter - Gramps has private
insurance. (You have asked the question,
haven’t you?) Looks like you must ring the
consultant direct. No worries. This is almost
always easier than phoning a registrar. The
latter moans and groans about getting
some obscure test done which is irrelevant
to their obviously needed admission. In
direct contrast, the consultant knows all
about costs in his private practice, and is
not fussed at all about anything but the
most obvious investigations.
Do have your story worked out well
ahead of the phone call. Doubtful
truthfulness is far less important than a
clearly constructed plan.
-’Hello, Mr. Shitbags? It’s the AO here.
Ummm, Admitting Officer. You know, The
Emergency Department? Yes, that’s right,
the ambulance bit. No, it’s actually been
here for many years, sir.
Anyway, I have a patient here with abdo
pain...belly sir ...and I’m having trouble
working out what is the cause. No, no
cause, not course, sir.
‘Pardon? Yes, I’m terribly sorry for
interrupting your function....no, no, I said
FUNC-tion....and yes, it’s a lovely day for a
barbecue. Your registrar? Well, he’s a little
indisposed at the moment sir ...yes. He is
stoned again, sir.........and it is a private
patient. Oh, you are too sir? No, no! I
certainly do not want you to come in! I
thought I would just stick him in the ward
and you could catch up with him
later.....Pardon...No, the patient, not the
registrar, sir.
‘Hmmm? Rebound? No, no, no! (You
make a mental note that you must feel the
abdomen next time before ringing a
consultant.) Sorry? Oh, yes I’ll wait sir...
‘Feel better now? Pardon sir? .....Umm, no,
I never have that problem. Maybe you
should see a Urologist or, even better, a
plastics person.........If we could just get
back to the patient, sir.....pardon... Well,
yes it does in cold weather.......no,
Urologists do that, sir.......Anyway, getting
back to the patient.....the one I just told you
about; what do you want me to do with
him? Stick him in the ward and you’ll see
him later? Oh, brilliant suggestion sir!
...And could you give the registrar some
coffee sir? I know it’s selfish, but I’m tired
of squeezing the other patient’s heart in his
ripped-open chest.....sorry sir? Oh,
heavens no, sir! This patient is PUBLIC!’
(vi) HOSPITAL UNION
REPRESENTATIVES
Thick and thieves
You can bullshit consultants easily. If
you are skilful, you may be able to bullshit
registrars. But union reps demand total
respect. Elsewhere in this fine piece of
literature, all areas of the hospitals are
treated with complete disdain. But union
reps could never be treated in this manner.
Possible repercussions prevent me from
saying much here; suffice to say that the
hard-working power base of the hospital,
who decide how the hospital is run, who
lives or dies, and whether we remain
employed or not, have my undying
appreciation. (Suck, suck.) My warning to
all: their power wilts somewhat with
conservative government, but take great
pains to be on their good side before their
militant power returns. Bastards.
(vii) ADMINISTRATORS
Thank God
Be not fatalistic in your lives as
Admitting Officers, dim though the light may
be. At least you are not an administrator.
These people are hated almost ass much
as AO’s - the difference is, they choose to
bring it on themselves. They include both
medically and non-medically trained staff,
who set themselves up as watchdogs of the
lazy, overpaid resident staff. (The latter
leading a charmed life at public expense
while still learning, apparently.)
Administrator desperately trying to tell
the big hand from the little hand… (on
$100k)
I am referring to some middle
managers. These people deserve any shit
they get through their own silly actions. It is
so easy for critics of minor medical
mishaps, (and the small perks of our jobs,)
when they walk out each night at 5pm.
Criticise me unfairly, and I respond badly;
especially from these types. At times there
is obvious envy of the young people
receiving pay packets around the same as
their own, or more, but without their
extensive experience.
They see this as undeserved, and
merely given to us! They lack all insight into
the amount and type of work residents must
do in order to get to this stage. When these
arguments are presented to them, they
either ignore you, or smile in disbelief.
At the same time as we are sweating
and swearing, this type of administrator is
spending his/her time in a cosy office, from
nine to five, or in a comfy, hospital-provided
car. One can only speculate on what they
find to do each day, apart from harassing
honest hospital workers. I believe
‘meetings’ occupy a lot of their time.
Apparently, these involve groups of people
with similar usefulness who discuss topics
of no interest to anyone but themselves. A
typical meeting sounds like it would involve
administrators, chiropractors, parking
inspectors, used car salesmen, people that
go to greyhound races and those guys at
the side of the road with ‘slow/stop’ signs.
Whingers
If only these types could be with you at
2am on a Sunday morning, with all the
drunks, lacerations, O.D.’s, MCA victims,
loonies etc. etc. etc. It just goes on and on.
But no, they’ll never see it. But come
Monday morning, there they are, whingeing
about the costs of transports, taxi-vouchers,
sandwiches, coffee, toilet paper etc. etc.
etc.
Abuse
Then there are the abusive patients and
relatives, who will complain to management
about you, the red-eyed doctor who was
rude to them at 4am on a Sunday morning.
They will say that they were sure you were
drunk or on drugs; never knowing you
haven’t slept for two days.
And administrators will console them! It
is wonderful to see these types are steadily
being replaced by co-operative and
supportive people, who understand our lot.
(I made that last bit up to calm new ‘terns)
 SECTION 7: GLOSSARY OF TERMS

WHAT DOES IT MEAN?

Absolute Constipation Chockers

-Failure
Accepted Relative Reassurance
-Good news, granny’s well.
Accept No Responsibility
-Latin for old nursing adage: ‘Accept no
responsibility.’
Active Evasion
-Dunny avoidance requiring the breaking of
phosphate bonds.
Administrators
-Unfortunate people with disturbed minds
hired by the Health Commission to
entertain and test the breaking point of
AO’s, hired though no choice of the
Commission, have no insight into their
usefulness, and they defy all reason and
insist on inhabiting hospitals.
-An ED jam-packed with Nitrogen, Oxygen,
Carbon Dioxide and trace elements - as
used in a description of one’s ED to a
doctor wishing to transfer a patient to you.
Cooking with gas
-Converting an O-sign to a Q-sign.
Custodian Virginatis
-The doctor suggests a more appropriate
institution.
Degenerates
-Sober ambo; drunk radiographer.
DILLIGAF
-Do I Look Like I Give A Fuck?
Dinkum Back
-Painful back, possibly with confusing
associated neurosis.

Admission Dolt
-Disaster! -dunnyette

Bastard Obscure Relative Dolt Management

-Your patient has money. -Sorting vegetables

Bidets Dr.Death
-Almost dunnies. -The registrar’s favourite intern.

Bin Dunnies
-Psychiatric Institution. -Untreatable vegetables.

Bloody Relatives Dunny Avoidance

-Bloody relatives. -No vegies today, thanks.

Bogus Back Dunny Classique

-Patient is a little confused which end of his -Untreatable vegetables least conforming to
spinal column is crook. the human form.

Bullshit Dunny Evasion

-Lovely! -Transferring a problem patient to a far
better qualified person.
Bullshit Flow
-An in-depth analysis of the situation at Dunny Rush Hour
hand. -Friday Afternoon.
Emergency Induced Forced Hospital Union Reps
Responsibility -Unfortunate people with disturbed minds
-Odd transformation; the doctor becomes a hired by the Health Commission through no
baby-sitter and the hospital, a motel. choice of theirs.

Factual Thoughts & Factual Facts Hygiene

- The truth is in there, and the truth should -A female dunny on drugs.
STAY in there.
Hyperactive Evasion
FIG JAM -Dunny avoidance at all costs.
-Surgeon: Fuck I’m Good; Just Ask Me
Kitchen Sinks
Fith -Not a dunny, and NEVER to be treated as
-Fucked in the head. such!

FLK Intern (syn. ‘tern)

-Funny looking kid. -Salaried medical student.

Frequent Flyer LMO - Refers only to those who

-See ‘Mega-dunny’. recognise themselves
-Local Moron Overseer
Fruits -Loathes Medical Officers
-Just near vegies -Locates Many Oldies
-Loves Masturbating Often/Others
‘Fuck’ or ‘Shit’ (Expletive by patient, -Little Meaningful Observations.
=Odd, or by doctor, =ring
lawyer) Loonies
-Goodness, the patient is very ill! -Unfortunate people with disturbed minds
who are hired by the Health Commission to
Gerry entertain AO’s.
-Interesting elderly patient - not insured. Medical Students
Gold -Unfortunate people with disturbed minds
who have no insight into their future
-The G.P. is wonderful usefulness.
G.P. Mega-dunny
-Gomer Producer -Patient with a history of more than one
-God’s Prick volume.
-Generally Pathetic
-Great Pain Mega Dunny Rush Hour
HBA Positive -Friday afternoon before the school
holidays.
-Love is in the air.
Minimization Routine
Hippocratic Hypocrisy
-Sharing, caring technique.
-Another day, another dollar, another
dunny. Multidirectional Antagonism
Ho-hum -Old nursing doctrine formed to ensure
things run as least smoothly as possible.
-See ‘Odd’.
Nursing Home
Honesty
-See ‘bin’ or ‘zoos’.
-No.
Nursing Supervisors Safe Suicide
-Traditional enemy. -A fun day out

Odd Self-snuff
-Overdose dunny. - Dunny accidentally ingests dangerous
drug
O-Sign
-A dunny you’ve almost succeeded with. Shat off
-Arrival at work to a full department.
Par Excellence
-Shit-hot. Shitty
-Nasty
Parturition
-The doctor has found a more appropriate Slag-off
area of the hospital. -A slough.

Passive Evasion Slough

-Dunny avoidance with least energy -Transfer of an interesting patient to
expenditure, someone else.

Patients Sieve
-Unfortunate people with disturbed minds -Tyro AO.
who defy all reason and insist on inhabiting
hospitals. S.O.T.D.
-Slag off that dunny!
Pork Chops
-The patient is so sick they can be Spanner
aggressive and argumentative. -Helpful advice which may cause a patient
to choose to not see you.
Private Excretion
-Rehab in a homely atmosphere Spinal Bidet
-Could be real.
Public Excretion
-Rehab in any atmosphere Spinal toilets
-Dubious back pain patients.
Q-Sign
-Now you’re doing well! Spinal Toilet Indicators
-A grouping of symptoms and signs in a
Reciprocal Suicide patient with back pain, possibly suggestive
-While assessing a ‘suicidal’ patient, the of a non-organic cause.
AO contemplates arranging his own
demise. Suitcase Sign
-Silly patient did not realise you were AO
Relative Dunnyism today.
-Perceiving gramps as a dunny on direct
comparison to someone who is unwell. Surgical Statue
-The intern is assisting
Rellies (syn.Relatives)
-Unfortunate people with disturbed minds Take-aways
hired by the Health Commission to test the -Nowhere near vegies!
breaking point of AO’s.
Threatened abort
Rudeness
-Blood in the undies of those who sit to pee.
-Reality
Thrustopelves
-The doctor suggests a more appropriate Wall
doctor. -Experienced AO.
.
Toilet Transplants
-Referral of a patient to another institution Washing
-Process unfamiliar to a dunny.
Unaccepted Relative Reassurance
-Bad news, granny’s well. ‘We have no beds’
-Hello?
Understanding
Zoo
Vegies (as in CVA) -Nursing Home
-Comatose