I switched jobs this week, going from the relative comfort of the infectious disease job to the busier territory of helming a general medicine team. As at Duke and probably most other large medical centers in the world, the gen med teams are the workhorses of the hospital, as most patients being admitted fit somewhere under the umbrella of internal medicine unless they are pregnant, under the age of eighteen, or going immediately to surgery. I was actually on call on my first day, taking in a steady stream of new patients from the emergency department, as well as fielding calls from all of the other services in the hospital whenever they needed medical advice, like when a patient on the orthopedic service got chest pain and the surgeons needed advice on what to do next. That much was all familiar to me – that’s basically how I spend a lot of my time at Duke. There were some surprises, too, like when it turned out I was running the code team – would have been nice to know before my pager went off and I saw the message “cardiac arrest in room 4A-25.” When in doubt, if I’m being alerted that there’s a dead/dying patient, I figure somebody wants me to know and I should probably proceed in that direction with some haste. But I was still surprised when I arrived at the room and it turned out I was in charge.

That was followed quickly by a string of calls from district medical officers, who as it turns out are people who oversee the far-flung clinics in the territory, those places like Yarralin and Kalkarindji where I went before. These clinics are staffed day-to-day by nurses, with intermittent visits from traveling docs, so when the nurses have questions on days that there is no doctor in town, they call the district medical officer. And it turns out that when the district medical officer has a question, he calls me. So I was overseeing airlifting operations for heart attacks, sixteen-year old pregnant girls with urgent blood pressure problems, and advising on lots of less urgent outpatient issues in between. In all, it was actually pretty fun – you either embrace the job or you soil your drawers, and I didn’t bring that many extra clothes with me.

I also found a new way to make oneself extremely unpopular among the emergency room staff. You might think that it would take the cake if you show up horrifically inebriated, abusive and in some state of filth. But actually this is common enough that a seasoned ED nurse won’t bat an eye for your average (or above-average) drunk. Ditto for strange objects inserted in strange places – good for a chuckle, but not much more. It takes something more bizarre to ruffle feathers, something like a patient I saw in medical school with maggots on her leg, some of which were actively transforming into beautiful baby flies which buzzed around the emergency department. And here it the northern territory, it takes a man walking into the department carrying a squirming death adder, as a gentleman did this week. He is a drummer in a local band, and a bit of a snake enthusiast, so when he saw a snake on the road as he was driving to a gig, he decided to help it off the road so it wouldn’t meet an untimely end. But I hope he is a better drummer than snake handler, because what he identified as a nonvenomous python turned out to be the rather-more-venomous death adder, a possibility that only occurred to him when he noticed that the reticent “python” had just buried its fangs in the back of his hand. Interestingly, the death adder reportedly has the quickest strike in the world – 0.13 seconds from strike position to envenomation and then back again, not to mention that it's considered one of the ten deadliest snakes in the world – so not the ideal elapid to try to handle. So his next thoughtful decision was that he better get himself to a hospital (correct), and it would help those treating him if he captured the snake and brought it with him, alive and annoyed (incorrect). The patient did okay, but I’m afraid the death adder did not enjoy its (brief) hospital stay quite as much.

I think I’ll leave it at that today. I would give an update of my enviable social life, but instead of titillating and scandalizing you with the details, I’ll instead give my personal ratings of the books I have read here thus far. Then you can imagine for yourself how I spend most of my free time (until Josette gets here and we start traveling in 27 days, but who’s counting).

Super Duper:
Saturday, Ian McEwan
A Long Way Down, Nick Hornby
The Yiddish Policemen’s Union, Michael Chabon
Fear and Loathing in Las Vegas, Hunter S Thompson

Quite Good, Possibly Super Duper:
Waiting, Ha Jin

A Pleasant Way to Pass the Time:
Sex, Drugs, and Cocoa Puffs, Chuck Klosterman
Special Topics in Calamity Physics, Marisha Pessl

The Weaker Cousin of One of the Five Best Books I Have Ever Read:
The Moor’s Last Sigh, Salman Rushdie

Not Recommended:
Skinny Dip, Carl Hiassen

Absolutely To Be Avoided At All Costs, Even Upon Threat of Bodily Harm:
The English Patient, Michael Ondaatje

Oh, and I am heroically working through David Foster Wallace’s Infinite Jest, 384 pages into the most complex work of fiction I have read to date, a mere 700 pages to go. I am an unabashed fan of his from his nonfiction collections – I would put A Supposedly Fun Thing I’ll Never Do Again and Consider the Lobster in the “Super Duper” category above. Ergo, I am undaunted by Infinite Jest, including the 100+ characters I have met so far, and the ninety-six pages of explanatory footnotes, including footnote #123, which presents an extended proof of something called the Mean Value Theorem, requiring a working knowledge of at least basic calculus just to understand the footnote, which itself barely sheds light on the overall thrust of the narrative (which I could best summarize thus far as tales from an elite Boston tennis academy, a halfway house for crack addicts and alcoholics, and some interspersed vignettes of militant paraplegic Quebecois separatists – I guess it’s pretty obvious where this book is heading, eh?). And while I like to think I have a vocabulary appropriate for someone who has spent about twenty years in school, I’ve been keeping track of the words I don’t know as I come across them, and the list is now running about 150 items long, including one single sentence in which I found the words “sallet”, “calpac”, “harquebus”, “calotte”, “escudo”, and “shako” (and I don’t mind admitting that I’m a little bit annoyed that my spellchecker recognized all but two of those). So if in my next post I write a prolix ghazal about an etiolatated phylactery, well, you’ll know why.