Friday, February 16, 2007

Final Report

It seems unlikely that I will achieve much more work this weekend - I've gt a lot of beer drinking and socialising planned... so:

1. Dentist visited; my teeth hurt more now, and I've gotta go again next month. I believe I'm putting his kids through College
2. Optician visited; eyes are fine
3. Hair cut; ears drafty
4. Hot water repair arranged; next week, I hope
5. Fence repair arranged; 10 days
6. House semi-tidy; about as good as it gets...
7. House re-mortgaged
8. Suits drycleaned.
9. Thought about painting; fail...
10. Paperwork up to date
11. And filed!
12. Audits still unwritten; fail...
13. Presentations done and done
14. Case report still in the pipeline; fail...
So, I got most shit done, and what isn't done should be within the week... not bad by my standards. Photos of fence to follow...
Oh, and I had my car serviced....
I realise this is all in a day's work for most people, but it's quite an achievement for me....


The news today is full of a story concerning an off licence use of Viagra (sildenafil) to further the recovery of a premie baby.

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:

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!*

That was published in 1996. I suspect the answer is 'none of us', now.

So give thanks today, not only for a life saved, but for a flicker of life in the Art of Medicine.
Operations that Made History, Ellis H CBE; Greenwich Medical Media 1996

Things That Are Really Pissing Me Off

The insistence of several publications in referring to "MSSA, a strain of MRSA".

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

Take A Little While To Grow Your Brother's Hair

Pure nostalgia tonight.

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;
or whatever.

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.

*(about 600 quid in Pa Shroom's day ( I know the bill will be more than that, but 600 is the suregeon's fee, and it includes all the post op care while your in hospital, which might be two weeks.)

Monday, February 12, 2007

She Has Robes And She Has Monkeys

She lives on Love Street...

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

Thought For The Day

"Sometimes you have to sink all the way to the bottom, before you can begin to climb back up..."

Saturday, February 10, 2007

Hardly Dr Kildare

I've taken a break from pilfering song lyrics to raid TV instead. The mighty Richard Chamberlain as arguably the first and most famous of TV Docs. (Albeit one fading fast from public consciousness now, I suspect)
The reason he's on my mind is another abortive attempt of mine to play the medical hero. Deep in the back of my psyche lies a part of me that longs to run around in orange jumpsuits, shouting "stat" quite a lot. To slake this beast, I'm prone to stopping at accidents, if it seems I'd be able to help. In my mind, I will undoubtedly perform an heroic intervention, smooth my hair back into place, and stroll off into the sunset, adoring crowds swooning behind me. In practice, there's actually very little to be done in most cases. Which is generally good. If there is something I should be doing other than providing reassurance, the patient / victim is unwell, and probably needs proper equipment.
Frankly I should just stop.
Besides which the Paramedics never believe you, unless you're a recognised Out-Of-Hospital provider and driving a flash car with "Doctor" written on the side; and even then I suspect they feel you're just getting in the way.
Today, I was driving to the opticians, when I came across a young woman recumbent under a car. In actual fact she didn't seem to have sustained any serious injuries, and was conscious and talking throughout; the doubt seemed to be about how to get her out... I suspect she could have been slid out on a backboard, but didn't stick around once the Paramedics showed up. I guess I know just enough not to make things worse. I think all I really achieved was lending authority to the request for the massive crowd of rubber-neckers to bugger off.
I guess I should just leave the heroics to the experts, eh. And the TV Docs...

Wednesday, February 07, 2007

What We Did On Our Holidays

Actually, what I need to do. I'm on leave, except for the odd night here and there. I've got a post or two brewing, but I thought I'd leave an electronic record of stuff I need to get done over two weeks, so we can all see how rubbish I am...

In no particular order....

1. Visit Dentist
2. Visit optician
3. Get hair cut (6 months goes by so quickly...)
4. Get hot water fixed in my house (it's been two years, I think...)
5. Fix my fence
6. Tidy my house
7. Sort a new mortgage
8. Get my suits dry cleaned
9. Paint my house (!)
10. Finish an interminable amount of paperwork
11. File said paperwork
12. Write up 2 audits
13. Prepare 2 presentations
14. Re-submit a case report
15. NOT spend all day surfing the net.
Wish me luck. Update to follow in 10 days. Some photographic evidence may be submitted...

Tuesday, February 06, 2007

Fishlady, Oh Fishlady....

I've struggled to post the past few days. I'm not sure why. The computer at work was being frustratingly slow, and I guess I get discouraged easily. Another of my enviable character traits. Not much has happened either, which doesn't help...

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.