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n Blood gas analysis<br />
interpretation can be<br />
complex. Joe’s fellowship<br />
exam acid-base talk consisted<br />
of only four essential points:<br />
1. Metabolic acidosis<br />
– sick<br />
2. Metabolic alkalosis<br />
– vomiting<br />
3. Respiratory acidosis<br />
– not breathing<br />
4. Respiratory alkalosis<br />
– not sick<br />
Bob Poulton | emergency<br />
physician, Melbourne.<br />
Former Western Health<br />
emergency medicine registrar<br />
n My earliest recollection of Joe was as a fourth year<br />
medical student. He took us for a tutorial in the ED. I don’t<br />
know what the tute was supposed to be about but he<br />
started out drawing a floor plan of a house with a dotted<br />
line going from front door to fridge and then to couch.<br />
He explained that what we needed to get was a filing cabinet<br />
and some vertical files and then chart a new route from front<br />
door to fridge at the end of each day that included a stop-off at<br />
the filing cabinet to drop the notes we had written that day into<br />
their relevant files. He said that if that was the only study we<br />
did we would be making a huge improvement on what we were<br />
probably doing. It completely transformed the way I studied.<br />
He then went on to quote W.H. Auden, ‘Most people enjoy<br />
the sight of their own handwriting as they enjoy the smell<br />
of their own farts’ as an exhortation to stick with pen and<br />
paper over the emerging trend of the computer as a way<br />
of collating study notes. It made all the girls in the group<br />
go ‘aww’ and all the boys go ‘hmmm, yeah, he might have<br />
a point there’. He couldn’t hold back the wave of electronic<br />
data collection but the message did stick with me.<br />
1When I was involved in a catastrophic upper GI bleed<br />
one weekend, with the endoscopist too far away, and the<br />
Stengstaken-Blakemore tube ended up in the right pleural<br />
space and the patient’s blood volume was on the floor, Joe<br />
told me about one of his own complications as a surgical<br />
trainee. He said, ‘If you are going to do big things, you are<br />
going to get big complications.’<br />
It was a great comfort to me and I hope it has been to<br />
others since when I have repeated it to my own trainees<br />
in similar situations.<br />
Mark Putland | emergency physician, Bendigo<br />
and former student. Emergency medicine registrar<br />
and emergency physician, Western Health<br />
29
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