Friday, February 16, 2007
This use is not really news. I'm sure you all know what Viagra is used for now, but it was intended as a drug to lower blood pressure. And it has found use in treating pulmonary hypertension in newborns before.
This provoked much controversy.
I must confess to being unaware of this potential use for Viagra before today, but received the news with great joy. Not just because a baby is alive who might otherwise be dead. But also because it does a little to restore my faith in medicine. There is a grand tradition of using unorthodox treatment in medicine. I remember my first boss reacting angrily when told by a drug rep that he couldn't use a particular medication in the way he did, because it was off licence. He was quite confident in his medical knowledge, backed by many years of experience. He reminded me that Registered medical practitioners are entitled to prescribe as they see fit. I suspect the local formulary has more to say about it these days...
In the 'good old days', I'm sure many unorthodox / experimental treatment was carried out without full consent. While I don't condone this, I can't help bu feel that the pendulum has swung too far the other way. In the modern age of Evidence Based Medicine and protocol driven care, delivered by practitioners with limited knowledge base and experience , there seems to be little room for the use of a medication or treatment for any purpose than the manufacturers intend.
I'm not proposing that patients should be peppered with untested drugs, or at random. But I think we are loosing the part of medicine that was, and is, it's art. The science is stronger than ever, but there should be more to it than that.
Sometimes you have to think laterally.
A Professor of Surgery, under whom I worked when I was an Anatomy Demonstrator wrote this:
That was published in 1996. I suspect the answer is 'none of us', now.
And how many of us, having carried out some new and untried treatment, have had this experience of being unable to sleep and of creeping to the ward before anyone else is around, with pulse racing, to see whether the treatment has been a brilliant success or a disastrous failure!*
So give thanks today, not only for a life saved, but for a flicker of life in the Art of Medicine.
MSSA, a term I have never heard used by medical professionals, is Methicillin Sensitive Staph Aureus. Or just Staph Aureus, really. Surely MRSA (Methicillin Resistant Staph Aureus) is the strain here...
It also occurs to me that the existence of MRSA where once there was only SA goes a long way to supporting the theory of evolution. Any Creationists out there, I welcome comments, etc
Tuesday, February 13, 2007
My experience of blogging strikes me as odd. While the process of writing is cathartic (although you could argue I could achieve the same thing by actuall talking to people), I have found myself inevitably drawn into the Blogging community.
I start to wonder who is reading this nonsense, and of course, I've started reading other peoples blogs. There are millions out there, so I'm sure I'm missing millions of great blogs; but those that I do read attract my attention, smetimes because they comment on my blog, sometimes because someone else recommends them.
Anyway, those that I try to read regularly I find well written to a fault, and all have something worth saying. Many of them express sentiments that I share much more eloquently than I could ever hope to. Variety is the spice of life, I guess. Like good books, these blogs can start to feel a bit like old friends.
Or new friends;
The point I'm rambling toward is that sometimes these folks go missing. Everyone has they're own reasons for not posting. None among us are doing this professionally, as far as I can gather, so life gets in the way. But... you can't help but wonder. Part altruism (are they o.k?) part selfish (I was reading that!)
Well, a couple of the blogs I follow had been silent for a while, and are now going again. Which is nice. I'm glad you're both posting again. Welcome back, for what it's worth.
I was watching an episode of TV Medical soap Holby City tonight. (If you're not aware of it, think Chicago Hope; if that doesn't help, then Nuts to you.) The entire episode was set during the late / night shift. It made me quite nostalgic for nights on call, if you can believe it. Then a number of glaring technical errors became apparant to me, and rage became my dominant emotion. I've self medicated with alcohol, though, so it's ok.
It does bring me to my own peculiar rose tinted specs. Hard and sometimes frightening as my nights on call were, I now look back on them with fondness, both as times when I was happy, and as a macho badge of homour. (I've been prone to use "In my day..." - type aphorisms since I finished my Pre-Reg year. (And, yes, I know, I'm an arse. But thanks, anyway.)) It makes me wonder, though... was it really any beter? The prevailing wind in medical politics at the mo' is that things are worse now than they were a few years ago.
This isn't quite the same thing. There is no doubt in my mind that that Bitch Hewitt has fucked the NHS royally. But it has pretty much been the aim of every Govt since 1948 to break the power of the medical profession. As to the idea that Doctors earn too much, I say Bollocks. Yes, we earn good money, but compare the amount a surgeon gets* for removing your cancerous intestine, and potentially saving your life with the fee a Solicitor gets for conveyancing your house.
They started it.
Nye Bevin promised to choke our throats with gold, and no-one stopped to think that good Health Care would become increasingly burdened, no less so.
I did have a point to make. I'll try to come back to it when I can think straight.
Monday, February 12, 2007
So I've reached halfway point of my leave.
Rather lamely, I don't feel I've achieved anything. I worked last Sunday night, so last Monday was a right-off, and then I worked Wednesday night too, so that ballsed up Weds / Thurs, and I've been fairly vegetative since. However, I am on track to have got things done, which is an unusual change for me. Details to follow at the end of the week. If Colossus is still out there, I know he's expecting much inertia. We'll see.
As an extra task, I'm going to try and hook up with a few old friends. Guys I went to school with, but don't see very often - both distance and the NHS get in the way. The problem I usually have is that they've invariably organised something to do- which is not unreasonable. I believe it's called having a life. I can almost remember when I had one myself... (cue violins, droning in the background)
But it's frustrating to find out all your friends are up to something you can't get involved with - usually because it's a ticketed affair, or whanot. A painful reminder of how far out of my old social circle I've fallen. Time marches on for all of us, I guess. I can't remember if I've mentioned this before, but Pa Shroom once told me he was meeting a friend of his, whose Best Man he'd been, but had hardly seen since. Naively, I used to wonder how such a thing could happen.
It's all too clear to me now.
Well, you pays your money, you takes your choice.
If any of my dear readers share my affection for Bruce Springsteen and the E Street Band, I urge you to invest in a copy of his live performance from 1975 at Hammersmith. But I imagine most of you won't be interested. Shame on you.
Sunday, February 11, 2007
Saturday, February 10, 2007
Wednesday, February 07, 2007
In no particular order....
Tuesday, February 06, 2007
So just a few random thoughts, I guess.
I think I've had another hard week; I'm not sure why. I'm due a break - in fact, I'm on one now - so maybe I'm just tired. Snappier than usual, which didn't endear me to my colleagues, I'm ashamed to say. What's done is done, unfortunately. We've seen a lot of overdoses this last week. Maybe more than usual; maybe not.
Feels like more than usual tho'.
In general, we do see a lot of this presentation. My experience of the psychiatric services in the U.K. has not been good. This is not an implicit criticism of the people that do the work; I don't know nearly enough to start down that line. It's merely an observation, and I assume the problem is an overstretched, understaffed service.
Part of the side effect I feel from seeing so many of these cases is that I start to become unsympathetic. This not a good thing; but I have to admit, I find it hard, when I see so many people who lie about what they've done, or what they've taken. People who seem to be in it to abuse the system, or, God forbid, for the attention.
Let me repeat - this is not right. I am not trying to justify myself. You just need to know. Well, as much as you need to know any of the drivel I'm prone to vomiting forth.
Well, I saw a couple over the last few days who really got to me. Regular people, not serial offenders. People whose lives had taken a series of turns leading them down an alley so dark they couldn't see the way back. Couldn't even see that there IS a way back. Neither of them had taken ODs likely to cause physical harm, so I referred them on the way. I'm not sure I was any help at all really, tho'.
On a lighter note, I was getting my hair cut today, and the place was awful cold. I became acutely aware of the temperature differential caused by the hairdresser. It's amazing quite how much heat a body radiates. Or not. Maybe you had to be there.