Religion in the Workplace

Came across this in my studying...

You are caring for a 75 year-old male in the cardiac ICU who was admitted with chest pain. His troponins were elevated and the interventional cardiologist plans to take him for an emergency cardiac catheterization. While you're discussing the diagnosis and planned treatment with the patient, he states that he is afraid of dying during the procedure and asks you to pray for him. Which of the following is the most appropriate reply?

A. "I'd be happy to call a chaplain for you, sir."
B. "I am not religious, but if you are then prayer could be helpful."
C. "I will keep you in my thoughts and prayers."
D. "We are not of the same faith, so my prayers may not help you."
E. "Praying is fine, but it has not been scientifically shown to be efficacious in your situation."

The USMLE answer appears to be C. There's nothing wrong with referring them to a chaplain but in an acute setting like this, physicians should recognize and respect the belief systems of their patients regardless of their own beliefs. The topic of religion should not taint the treatment of a patient in any way and religion should only be discussed if brought up by the patient. Their religious beliefs are to be used to help ease their burden and should never be disagreed on by the physician. In the interests of non-maleficence, the physician should at least agree in a generic sense to keep the patient in their prayers.

Toilet Technique

Living at the staff nursing quarters here in Ayr means that I've had to use a lot of shared facilities such as kitchen, showers and toilets. Kitchen isn't that big of a problem. It's a bit annoying to have to label all of our food with 80% of the fridge space being ours. The couple nurses that have been living here off and on with us are very clean. It also helps that one of them doesn't appear to ever cook and the only thing he has is a freezer full of Camembert cheese. Looks like he's stocking up for a war or something.

The showers are a bit more iffy but still not too bad. A very brief inspection didn't seem to turn up any mould. Can't see anything without my glasses anyway - ignorance is indeed bliss here. If there was a bit more traffic in the showers I'd probably keep my thongs on to avoid picking up some HPV.

Now comes toilets. I can't stand using public toilets and will go to extreme lengths to avoid a #2 or #3 in a public washroom (1 + 2 = 3 :D). #1 is less of a problem. But being here I've had to face the inevitable task of using public-ish toilets once or twice daily. Here are some public toilet strategies I've picked up:

1. Toilet paper seat cover
- so apparently many female toilets have toilet paper seat covers provided. Guy toilets don't (I've never seen one with them anyway). Three pieces carefully placed posterior and laterally does the trick. Probably psychological comfort more than anything since you can't really catch an STI from a toilet seat. Pubic lice jumps but unless your toilet seat is made of hair, the risk is almost nil.

2. No pants
- have you ever walked into a toilet where the floors are soaking wet and you're wondering what combination of bodily secretions and other substances are floating in it? How do you do your business without getting the bottoms of your pant legs dirty? If you wear skinny jeans then you probably don't have to worry. But for me, having your pant leg drag on the ground is a worry. If there's a hook on the inside of the bathroom door I'll often take my pants right off, hang them up, and put them back on afterwards.

3. Shorts over one leg
- so I just recently came upon this strategy. It's a form of the no-pants method and works best with shorts and thongs. What you do is you take one leg out of your shorts and swing it over one of your legs before you sit down. With the "shorts-over-one-leg" style, you maintain maximum range-of-motion with your legs AND avoid having your shorts touch the floor. Too easy!

4. Use the paper wisely
- always use paper to touch things without your hands when possible! Examples include lifting the toilet seat to stand and pee; flushing (as I've already mentioned); and opening doors on your way out. This is sometimes hard with the increasing numbers of hand dryers so sometimes I have to sacrifice my pinky.


Always on the lookout for more toilet tips.

Asian Food Store!

One week down, five to go. Things have been going pretty well here in Ayr. I feel like I've finally settled into a bit of a rhythm and I'm excited to see what will happen next. It doesn't feel like a "home" though...I carry my towel, soap and shampoo to the showers every morning; I have to close my door and take keys whenever I need to pee; I have to wear shoes whenever I leave my room; and my butt is killing me cuz all they've got here are these plastic chairs. But, all in all I can't complain because I have running water, electricity and a bed to sleep in at night. It could definitely be a lot worse.

I snapped a few quick photos of the hospital. It's much bigger than what I expected, which was essentially a beefed up general practice. It has 30 beds in a general ward with 24 hr nursing staff, an emergency ward with four beds, four outpatient consultation rooms, a couple minor procedure rooms, and some other consultation rooms used for visiting specialist clinics (eg. pediatricians, psychiatrists). There's a devoted mental health ward located just below our nursing staff quarters where they run clinics Mon-Fri from 8-5pm.

Also, to my surprise, they have a surgical ward with two operating theatres and everything to support them. On Tuesday we were able to observe and assist in a few procedures including a few excisional biopsies, a breast biopsy, surgical decompression for carpel tunnel and a vasectomy. One of the doctors here has diplomas in Obs/Gyne and Anesthesiology and that allows them to perform procedures requiring general anesthetics. They often have visiting surgeons come in to do scopes and other procedures the other days of the week. So far, I'm liking the feel of rural medicine. It's a mixed bag of medicine, surgery and general practice topped with a bit of trauma and emergency medicine. Our preceptor is a certified ultrasonographer so does heaps of stuff by himself. He'll perform all of the antenatal scans himself, do echocardiograms, and will even take people from emergency presenting with abdominal pain for scans to rule out anything sinister. I'm really quite impressed with how versatile they are.

We just went to grab a few groceries from Coles before it closed (not much is open on Sundays here) and we spotted this tiny Asian food store. We had asked a bunch of asians we bumped into at Coles if there was an asian food store in town and they said we'd have to go to Townsville. So when we saw this place, I was thinking "they lied to us!" We went in and found out that it had just opened up 3 days ago. In fact, it was so new that they didn't even have everything priced. It was great though, we picked up some curry paste and chili paste to spice up our food and grabbed a box of instant noodles. Finding the only asian food store in town was the highlight of my day lol.

We usually use this korean brand chili paste in a red tub but this will have to do for the next 5 weeks. =)

Church Hunting Again

After spending the entire day doing some practice questions for Step 1, I'm feeling extremely unprepared for this exam. I pretty much haven't gotten any decent studying in for the past 2-3 weeks and I've only got about 3 weeks to go. I was contemplating not bothering to find a new church tomorrow and just staying in a spending another full day studying.

A part of me thought, what if I just read my bible for a bit and spend some time in prayer? Would that be a sufficient replacement for driving around trying to find a building to sit in for a few hours? After all, church is really about a body of believers worshiping the one true God together in unity. So what if Albert and I just get together and study the bible and pray together? Maybe even sing a few a cappella songs? I know it sounds bad but I'm only here for 6 weeks and for the next 3 weeks I'm going to be spending every spare moment cramming. Is 6 weeks enough time to even join a small group and make it worth the effort?

After a bit of consideration, I think I will go find a church to attend tomorrow. Not that there's anything innately wrong with having a two-man church service with Albert. I already missed one last week because I was driving up to Rockhampton. It will be a great way to start my day and I really need to stop avoiding most social contact and meet some new people. Who knows? Maybe I'll meet some people who also work at the hospital. Maybe I'll make some friends for life. Maybe I'll even meet some super awesome bogan-ish girl...or maybe I'll just be able to spend some quality time with God.

I think I'll check out St. Andrew's Presbyterian Church. I had a look at the Presbyterian Church of Queensland website and their doctrine of faith looks pretty good. Another possibility is Burdekin Baptist Church but I can't find any info about them other than the address and 9:30am service time.

There's a Christian Outreach Centre (COC) here but having a look through what they believe, they have a big emphasis on speaking in "other tongues" through the baptism of the Holy Spirit, the gifts of the Holy Spirit, and prophecy. Are these languages or self-edifying spiritual babbling? On a similar note, there's Burdekin Community Church which is part of the AoG Churches. I know this sounds bad but, since I know I'm visiting and will be attending a maximum of 6 services, I'm tempted to go to a COC or AoG church for their lively worship atmosphere. I know I should commit it to God when it comes to becoming an active part of the a church body. But what about when you're traveling? I know I'm probably not going to join a ministry in 6 weeks so can I be a bit more self-interested? Is it right for me to choose one that meets my spiritual needs whether it be good preaching or a certain style of music for worship?

In the end, I feel it probably wouldn't be good to attend a church when I'm already having reservations after reading their statement of faith. So I'll give the Presbyterian Church a shot and, if necessary, check out the Baptist church next week. Or maybe we'll go visit 6 different churches - a different one every week - and compare the experiences as a little experiment. Perhaps even go visit a Kingdom Hall and/or Stake House. I wonder if there are any opinions out there on whether a Christian should visit and participate in say a JW or Mormon worship service. Normally I wouldn't wag my own church service but in this case, I'm unable to attend my home church anyway. Is it possible to attend a JW or Mormon service, maintain respect for their practices as a "visitor" and also respect God by not engaging in idolatry? It seems like it would be an enlightening and educational experience (combined with a chance to exercise your apologetics during the post-service prosthelytizing). I'll have to give this some more thought...

Woop Woop

"Woop Woop" (Australian slang)
Def'n: a collective description for any destination outside your local area (eg. a small town out in the middle of nowhere)

Alright, time to revive this blog with a long-ish post about what's been going down =)

Finally wrapped up my first week of my rural rotation. The days seemed to go by agonizingly slow as we pretty much sat through lectures and pracs from 0800-1700 each day - a painful reminder of what learning was like in the previous two years. Not all of it was bad. I feel a lot more comfortable with my cannulation and suturing technique after a skills workshop. We had a really great lecturer from Cairns come in to talk to us about bush bugs and a do a review of ECGs. We had a local snake expert come in and talk to us about, you guessed it, snakes. He gave us this guide if you get bitten by a snake:

Before you get to the hospital...

1. Do not wipe the wound
- many snakes are non-poisonous and the ones that are often won't inject venom for every single bite (unless you really piss the snake off)
- BUT, just in case, leave the wound as is so you don't facilitate the spread of the venom

2. Mark the bite location with a pen
- Depending on the snake, there may be two inconspicuous puncture markings or there may be a huge bruise the size of an orange (I think he said pythons are known to have very large bite marks because they latch on and chew on you...but the ones here in Australia are non-poisonous).

3. Do not try to catch/kill the snake
- Most bites occur when the snake is startled and feels it has nowhere to run
- With the exception of adders, most snakes will try to run away first. Adders will freeze like a deer in headlights thinking that if it doesn't move we can't see them. They'll only bite you if you aggravate them or corner them so that they have nowhere to go.
- Taipans are super fast and can bite you 4-5 times as they speed past your leg.
- Brown snakes are the leading cause of snake bite deaths in Australia
- Sea snake venom is the most potent but they will rarely attack unless you make them really angry. Apparently you can swim along with them and they will ignore you (but I wouldn't encourage it)
- Having said that, you'd have to get pretty close to identify the snake so probably best to just avoid.

After you get to a hospital...

4. Apply compression and immobilize the bite site
- most bites are about 1 cm deep (shallow envenomation) and venom will move through the lymphatic system. Therefore, compress and limit muscular contraction to limit the lymphatic spread.

5. Investigate with venom detection kits, urinalysis, and bloods (especially INR since the venom often contain pro-coagulation factors)
- I think here in Australia they have venom detection kits for every single type of venomous snake out there.

6. Treatment includes IV anti-venoms
- Because of available anti-venom agents for all the poisonous snakes in Australia, the mortality rate from snake bites is very low for those who are treated promptly.

**For more detail on how to manage snake envenomation, read here.

We also watched an interesting video on a remote Indigenous community in the Northern Territory. Seeing condition of the community made me think about some of the Native American communities in Canada and just how they are often neglected by the government and the rest of the country. Here people were living in 3rd world conditions and had life expectancies of 45 yrs. It just reminded me that you don't have to travel very far to find people in need - they're living right in your city - and you probably don't have to even leave your province or state to find people trying to survive without the basic necessities like clean water/food/shelter. I find I often talk about how it would be nice to travel to Africa on a medical mission but is it necessary to fly around the world? Instead of flying 12 hrs across the globe I could drive 12 hrs and probably find people in an equally unfavorable condition and in need of aid (at a fraction of the cost). I suspect that the same holds true for spreading the gospel of Jesus Christ...


Speaking of the gospel, I was so happy to have the privilege of serving in RICE Brisbane 2009 with heaps of others in an inter-church, non-denominational teen outreach movement. In only it's second year since inception (inspired by a similar movement in Sydney), I was very impressed with the unified efforts of so many who have a passion for serving, a passion for teenagers and most of all a passion for Jesus Christ. The theme was "A Tale of Two Kingdoms" and everyone was challenged to live in a way that reflects God's eternal kingdom right here, right now. During the event, I spent a lot of time backstage with the rest of the music team so I can't wait to watch the video of the entire evening. The games were awesome and I could hear everyone having a great time with them. The skit team did an amazing job, especially with the hand mime to Casting Crown's "Who Am I?" In fact, there were so many people working/meeting behind the scenes for many months prior and also during the evening to make it all possible. They deserve a lot of credit for going through all the planning and overseeing everything. The tech team was unbelievably slick throughout the evening and Eugene Hor delivered a powerful message that I know has helped changed at least 17 lives forever. Soli deo gloria!

I grabbed a few photos of the music team off Facebook (which might be copyright infringement) 'cuz I wasn't able to take any during the evening. If I'm not allowed to do this someone let me know and I'll pull them off.

I probably should have split up this post into multiple smaller posts. Oh well...
We arrived in Ayr at around 1620 on Friday and, with the help of Ping's GPS (thanks Ping!), made it to the hospital without any dramas. We met some of the nursing staff there and they seemed really nice! They showed us to our rooms in the nursing staff quarters right behind the hospital where we will be staying for the next 6 weeks. I'm so glad I'm not traveling alone 'cuz this place is FREAKY. As we were hauling some groceries back in the dark, it was like a scene straight out of a horror flick. Dark, narrow hallways with a few flickering lights (most of them don't work). None of the clocks are working and the whole place smells like nobody has lived here in ages. My room door shuts really tightly (you pretty much have to slam it to get it closed) and is so hard to pull open that a few times I've started to panic thinking I was trapped in my room (I should NOT have watched "Room 1408"). There were birds outside making strange, crying noises throughout the night. There's also some random old nurse named Philip living in one of the rooms next to us who we met last night. It was after 11pm and we were getting ready to sleep. We were standing in the dark hallway outside our rooms talking about what we should do the following day when we saw this guy emerge from the stairs at the end of the hall and start walking to us. I probably would have crapped myself if I was alone. I locked my door overnight and considered leaving my lights on. I'm going to have to fluid restrict myself after 8pm 'cuz there's no way I'm waking up in the middle of the night to use the bathroom.

Luckily, I'm not in room 13 (Albert is). The well-lit room interior is actually not too bad. It was nice to finally unpack my stuff from my suitcase. I have a lot of ironing to do this weekend >_<

More stories from the crypts of the Ayr nursing quarters to follow...