Q&A with Michaela Cartner

Questions and Answers

What have you been up to this weekend?

I went to a flip frenzy with my partner. He plays competitive pinball.

What sort of people do that?

All walks of life. It’s very inclusive.

Are you allowed to jiggle the machines?

The pinball machine doesn’t like being moved, it cancels your game. But you can bash the side., that’s a recognised tactic, as long as you don’t do it too hard.

You’re dual trained in ED. Do you miss the road less travelled?

No, actually. Because the emergency I trained in is different to what it is now. It’s more challenging, there’s much more politics, different patient flow routes. I don’t miss that aspect. I don’t even feel particularly nostalgic. I love my job.

Do you think that ICU and ED are growing further apart?

I don’t think so. There is always going to be a connect, with the patient load going from one to the other. But they are becoming more and more specialised. There are many more single ticketers going straight into ICU. There are less dual ticket trainees. Therefore you don’t get the nuance you do from working in another system, whether it be anaesthetics, ED or physician.

Do you think there is a fundamental character difference, between intensivists and emergency physicians?

No. I think medicine is big enough to fit lots of personalities, even within the one specialty. You get intensivists who like to charge ahead and do things quickly, bang bang bang. But you also get emergency physicians who are thoughtful and would like to sort things out in their own head. I don’t think there is one stereotypical thing.

Do you have a tidy bedroom?

Oh yes. I do now. Because I have a tidy partner.

What does he do?

He’s an emergency physician.

What was your most painful diagnostic miss?

Probably the one that stings the most… I admitted this lady who had a long and complex medical slash neurological history. She’d been seen by multiple surgeons, nine or ten neurologists, all in the chart, seven volumes, giving their erudite opinion. Every now and then she would come in, you would stop her meds, wait for her to become less crazy, and then you would restart some of them and she’d toddle off. So I had her at the weekend, and thought here we go again, this has been going for at least 35 years. I made sure there was nothing particularly obvious, and handed over to my colleagues.

Uh oh, here it comes.

He said you’ve repeated the serum rhubarbs? I said nope. You’ve repeated this, this and this? Nope. You’ve at least got an MRI? Nope. I walked off thinking, that didn’t go down well. But thought, what more can you do? That was Monday. On Friday I got a one-word text. Porphyria. It was my one chance to diagnose it, in my career. I stuffed it.

What really irritating things do emergency physicians do?

When they call you down, to a patient in a resus bay, and the consultant comes up and says they’re in there, they are sick. And I say oh okay, what seems to be wrong? And they say I don’t know, they are sick. Go and unsick them.

Your most cherished save.

A gentleman who was doing badly after cardiac surgery. I was liaising with the surgeon, the anaesthetist, they were all coming, but it was in private, and you are by yourself a lot. He arrested. So I reopened him. Tamponade. There are very few times in ICU where it is just you. It’s such a big team sport and you can’t be a single operator. But in this case I had to be. He ended up fine, completely neurologically intact. That felt really satisfying. Thank goodness for the nurses though.

Favourite recipe. Kitchen.

The new one that I have just cooked, tonight. A lemon delicious. And it’s well-named. It’s a pudding, you beat up the eggs, like a lemon souffle… with lots of self-saucing stuff down the bottom.

What’s the next big thing? In medicine. Not kitchen.

Probably cancer therapies I’d say. As an intern on my very first day I looked after a woman in her early thirties dying of metastatic melanoma. This poor woman, just riddled with melanoma. That is a curable disease now.

The most overhyped thing in ICU that turned out to be a complete dud.

Activated protein C. Vitamin C is next.

And your favourite machine that goes ping?

I’m not sure I have a favourite. People are always more interesting. I do focused cardiac echo but I don’t do TOE. …Ventilators have ceased to be interesting… ECMO is the biggest machine machine that goes ping, and I troubleshoot that but I don’t put in the cannulas…

I’m going to push you for an answer. What’s your favourite machine that goes ping?

My iPhone. It pings when coffee arrives.

Michaela Cartner will be presenting at the Spring Seminar on Emergency Medicine, Noosa, 18-21 October 2022.