Awaiting the Chop

Feeble sunlight trickled through the dew-drenched windows. The patients were finishing their breakfasts. The medical student wiped the sleep from his eyes and followed the team into the next room.

“Dr. Randall, Mr. Jackson hears better on his left side”, the house officer volunteered the hard-won knowledge to his consultant. “Or should that be: worse on his right…”.

“Hello, Mr. Jackson.” Dr. Randall spoke with the uncommitted voice of a doctor trying to ensure a patient wakes up and responds, whilst trying not to startle him too much.

Mr. Jackson half-sniffed. His wrinkled eyelids stayed shut.

Dr. Randall paused before lightly grasping Mr. Jackson’s right elbow and with a gentle rocking motion loudly chirped, “Mr. Jackson, good morning!”

Mr. Jackson tilted his head back with a slight twist and a yawn, his eyes opened to a squint and he looked down his nose to see a young smiling geriatrician crouched at his bedside.

“Oh, morning is it?” Mr. Jackson replied, as if speaking over the din of the happy hour crowd at his local pub.

“Yes, good morning. I’m Dr. Randall, your geriatrician.”

“Electrician?”, Mr. Jackson shouted back in surprise.

“No, no, I’m a doctor who looks after the elderly”, Dr. Randall spoke as loud as he could manage without an outward show of strain.

Mr. Jackson’s quizzical facial expression was unchanged despite the clarification. The rest of the team stood silently behind Dr. Randall, half-awake but preparing for a long consultation.

“Well, I read in your notes that the urology doctors have already seen you this morning. What did they say?”. Dr. Randall was now bellowing at his patient. Yesterday the geriatrics team asked the urologists to give their opinion on what to do about an unsightly mushroom-like growth on Mr. Jackson’s penis.

“Who?” Mr. Jackson was probably the only patient on the ward who had not heard the question.

“The urology doctors!” Dr. Randall shouted desperately.

“Urology?”, Mr. Jackson shouted back with equal force.

“Yes!”, the geriatrician’s face was turning plethoric and had become grotesquely ridged by distended vessels.

“Oh them, they looked at my whatsit.” Mr. Johnson pointed between his legs.

“Yes, that’s right”. The words leaked from Dr. Randall’s mouth like air escaping from a deflating balloon. The last breakfast trays were taken away. Dr. Randall summoned up all his reserves for the final push.

“What did they tell you?”

“What?”

“WHAT DID THE UROLOGY DOCTORS TELL YOU?!”, a fountain of saliva sprayed from the doctor’s mouth.

“Who?”

“THE DOCTORS WHO LOOKED AT YOUR WHATSIT!”

“Oh them”, Mr. Jackson folded his arms.

What did they tell you?”

“You’re going to have to speak up. I’m a little hard of hearing you know”, Mr. Jackson leaned towards the exasperated and wilting doctor.

“WHAT – DID – THEY – SAY!”

“What did they say?… They said… they’re going to chop my knob off!”

Mr. Jackson’s voice echoed around the still ward. Everyone was wide awake.


Half of us are blind, few of us feel, and we are all deaf

Sir William Osler

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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