The Stench Of Gin and Remorse

A few images:

Both MR views of the patient with a T6 fracture from previous posting

Before...

After...

A nice reduction of a trimalleolar fracture, done by one of our students. We were generally impressed.

Not much happened of note today. Lots of docs, not so many patients. I did, however, receive a rejection letter from the Annals. Which basically sucks. Ah, well. Try, try and try again.

One of my good friends and colleagues has discovered that I pollute the blogosphere with, well, this. He's now quite keen to read it; I'm not sure I want him too, which is essentially lame, but there you go. Anyway, he's set on trying to find me, but I suspect he'll:

• forget
• lose interest.

If you have found your way here Colossus, welcome aboard. I'm fairly sure I haven't ben rude about you, so - enjoy!

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Started reading something or other about Jack The Ripper. Nice.

The Rag Man Draws Circles...

Another tough day.


I feel shit today. But that's my problem. More of that later.


Yesterday...

I had a tough day, but it was bookended by two people having it far worse...

It began:
A young fella, fallen from a window. I'm not sure how. In the final analysis, does it really matter? We always ask 'how?' People rarely remeber. Why should they? It's the last thing on their minds. How he landed was more important, but we don't know that either. He was admitted overnight, so one of the other middle-grades worked him up. The unalterable truth, the only detail that mattered was the sensory level at T8. Below that, he could not feel a thing. Not a flicker of movement, no reflexes.


Nothing.


By the time I came on, at eight, he was still waiting for a CT scan. All the important folks had been contacted, and all offered the same grave opinion. I was to go down with him. Hold his hand. Sympathise. Console? Give him morphine, really, and try and keep him calm.


The Department was empty at eight. By nine, we were drowning, flooded by a tsunami of octogenarians. (This phrase was coined by one of the SHOs. Thanks, Baron)


We stayed in the Department, he went down without me.




The scans didn't bring better news.

Peg Fracture

Burst Fracture T6

Significant intrusion into the Spinal Canal

The MRI wasn't any more encouraging.

So the most significant part of my day was telling a family their son would never walk again.

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The day ended with my relief not showing up. I was already tired, but someone needs to stay on. As one last offering, the Ambulance service spewed forth another wretched supplicant. A young man. Found collapsed. How? We always ask... no-one knows, but we always ask. How long? We always ask...

I had hoped to get the SHOs to run this case, but it was too complex. He was too unwell. My brain chose this moment to slip into neutral. Running on autopilot. Back up arrived promptly from the ITU. Every question we ask gets a worse reply.

---How long was he down for? We don't know

---How's he been since you found him? He arrested just after we got there; came back after four minutes, but he hasn't woken up

His blood pressure wouldn't hold up, his ABGs were rotten. At least his sugars and his temperature were normal. He rides down to the scanner, accompanied, but unaware. The scan comes back normal. This is as close to a good thing as you can get in a situation like this.

The second significant thing I did was tell another family their father was in a deep coma, and I didn't know why, or for how long.

We did manage to relocate someone's ankle in the meantime. I'll post the films after the weekend, as it's an excellent job, and the guys that did it deserve credit.

Why do I feel shit? I don't know, but I slept badly, and woke up with swollen eyes and a sore throat. Coming down with something? Probably. Would help me explain why I slipped into neutral last night. I hope the patients didn't notice.

Monkeys for Everyone (Mainland Europe only. Some restrictions apply)

I spotted this in the London Times yeaterday. The Government has set up a web page, enabling any Tom, Dick or Harry with internet access to send them an 'e-petition'. This has great scope for mischoief, and the British public has not disappointed.
A petition to equip disabled people with helper monkeys, seems well within the grand tradition of tomfoolery, or gentle mocking of authority. What the Times, and indeed I, find more interesting is the Government's response.

For those among you who can't be arsed, the most salient point seems to me to be:

While we are aware of similar initiatives already in existence, the Government does not currently have any plans to make monkeys available to people with disabilities

Aware of similar initiatives..? Anyone know? Are the French giving out helper monkeys? The Spanish?

Good Times, Bad Times

Something of a mixed bag.

Somedays, I feel like I'm flying at work - not literally, you understand - but in that everything I do works, goes smoothly and results in fantastic relief for all my patients. No matter how complex the problem, or how many patients the God of ED lobs your way, I manage them all, slickly, with aplomb, leaving everyone wanting more. (Who was that masked man... **swoon**)

Somedays it feels like I'm swimming through treacle, carrying breeze blocks chained to my balls.

I must admit, I think I thrive on stress. When the Department is busy, it gives me the chance to pretend like I'm in ER, dashing about, shouting 'important' orders, saving lives. It's an ego boost when the nurses refer the complex cases, or sick patients to me.

The Arrogant Shroom knows it's because I'm just that damn good.
Realist Shroom knows it's because I'm the only senior on the floor.

Busy days give Shroom the opportunity to fly, wowing everyone. (In his own mind, in case this isn't clear - Ed.) On a bad day I'm prone to decompensate. Today was one of those days. The Department filled up pretty quick with patient after patient needing close attention, and after I had three on the go, and the Charge Nurse pulled me to one side to tell me there was someone sick as a dog in Resus, I was ready to tear my hair out. Fortunately several of my bosses were about, so I had some support, but Arrogant Shroom doesn't like to have to admit that he's only human, and can't single handedly cure the entire South Coast.

So, today we had:
--- 96 y.o female, probable stroke, GCS 7
--- 86 y.o female, collapse, hypothermic, low GCS
--- 18 y.o. male, fall, with head, arm and leg injury
--- 81 y.o female, found collapsed at home, possible stroke, possible MI

These guys didn't all arrive at the same time, but they were all here at the same time, and all ended up with the Shroom as their Doc du Jour. It felt a bit like fighting the Hydra, chopping off heads left, right and centre, only for more to spring forth. Fortunately I have the support of many excellent Docs and Nurses, not least to stop me getting an over-valued idea of my own self-importance.

The last two patients in my run of six affected me the most. One was an elderly chap, who had collapse in the barbers, and arrived GCS 3. We worked on him a bit, and he perked up to GCS 7. If he was another stroke, not much was on offer. These cases do badly, and end up with left lateral and TLC (tender, loving care) until it's their time to go. If it's a big bleed... well, you never know. The Boss couldn't find enough clinically to call it a stroke, so we headed for the Doughnut of Doom.

For those not familiar with head CTs, all that white stuff in the middle of the picture is blood; and none of it where it should be. Unsurvivable; unsalvagable; do not pass go, do not collect £200. Time for bed, sir.

We had to call the fella's wife in. Sometimes, when the patient is elderly, their spouse - also elderly - has no idea what's going on. I feared the worst in this case, as the lady had no-one to come with her, no support, no-one to lean on. When I stepped in to see her, she was one step ahead of me - had heard it in our voices, she said. Her strength in the face of the horror I unburdened onto her took my breath away. To lose your soul mate of decades in the blink of an eye... I can't even begin to imagine it. This woman's quiet, dignified grief made me ashamed, and I'm not sure why. But I'm glad we had our diagnosis, and I'm glad we could keep him alive long enough for her to see him one last time. Too many people shuffle off with only people like me for company.

The second case has a brighter outcome, so far. Another elderly chap, this time with severe chest pain. Initial ECG, in the back of the Ambulance was non-diagnostic. Then, as he was rolling up outside, that all changed. His ST segments pulled up in II, III and AvF. Barn door inferior MI

Time for a spot of thrombolysis. For this patient, the agent of choice, in this hospital, is the venerable streptokinase. The patient was understandably shaken when I told him what was a'goin' on. But he got with the programme, and we plumbed him into the magic clot-busting elixir.

I fucking hate streptokinase.

Half an hour later, they called for me. The patient was sitting up on the trolley - pale, clammy and gazing off into the distance. I can't quite put it in words, but I've seen this look before. I'm sure all medics have. 'The lights are on, but no-one's home' is the closest I can get. His gaze began to drift off, and his breathing became stertorous, almost as if he was trying to blow bubbles.

"Sir?"

No reply

"Sir?"

Fuck all.

Shit. This guy is stroking out. Right here. Right now. (Activate drama queen mode)

Convinced h was about to arrest, I asked someone to get the boss. I figured if he went, we'd need to scan him quick - if we got him back. His pulse, BP and sats were actually holding up, but he wasn't doing much to keep things that way. I dumped him flat, and got out the BVM, all the while calling his name, and trying not to shit myself.

(This is high on the list of ways NOT to look professional, and co-incidentally, high on the list of things to avoid doing at work)

Sure enough he became apnoeic, for about a minute - felt like an hour - and then came round. Whilst I was overjoyed to see him awake, and alive, this is tempered by the fact that he now thinks I'm a fucking halfwit, as he feels fine, and can't understand why I've got a mask clamped to his face, screaming hysterically.

At that point, the door bursts open - "I couldn't find the boss, so I got two SHOs!" God love my SHOs, but two junior docs, does not equal a consultant.

Subsequently, our patient's ST segments resolved,and he started feeling better. We have commended him to CCU.

I fucking hate streptokinase.

A light note to end on. What my American colleagues would call the Throckmorton sign, a phenomenon we refer to as Percy Pointing to the Pathology. False in this case, but a nice sign, nonetheless.

Nurse, The Screens!

A morally satisfying weekend educating my fellow medics, as the scramble to get MMC boxes ticked heats up.

I also managed to see Ma and Pa Shroom. I was slightly concerned to hear that Pa Shroom's memory is fading. I'm sure this is, at least in part, because he's retired. When he was working, and I was a student, I was always amazed at his superior knowledge of anatomy - even for those bits he didn't cut regularly. Now Pa Shroom bemoans the loss of this knowledge, and he was telling me his short term memory is failing him too. I hope that's all it is. I couldn't bear to see him dementing...

After my hapless flailing at the fairer sex on Friday, a cheeky note from a fellow Blogonaut brought light to my soul. Thanks again, even if you were humouring me.

As the philosopher Springsteen once wrote, "Don't call for your surgeon, even he says it's too late: it's not your lungs this time, it's your heart that holds your fate."

And to finish, a picture that I 'discovered' this weekend it took my breath away. The essence of human spirit?; or maybe just a young, scared boy running for his life...?

More Light Relief...

Either before, or after my previous post, I'd like you to read my current fave joke:

Q: Where is a gorilla in a Mini Cooper likely to be going?

A: Anywhere he God-Damn wants!

(I said it was my fave, I didn't say it was funny)

Maudlin Rambling

More jibber...

--- More about drugs (and the arrival of a fictitious Editor - Ed.)

I said in a comment a while back that I had taken a few liberties with the timeline of events herein. Allow me to elaborate. While I am writing this now, some of this had been going on awhile. It may appear more immediate than it really is. I'm actually regretting bringing the whole thing up, but it is something that gives cause for concern. (No shit, Shroomy - Ed.)
I know a little about drugs from personal experience - booze and fags (and coffee, I guess) being my poisons of choice, so I feel like I know a little about the addiction that makes them so ruinous. Medicine is renowned for being stressful, and some medics almost wear it as a badge of pride. Mostly the more macho end of the spectrum, but you get the idea.
Nonetheless, what is less braggable about, whatever your frame of reference, are the accompanying high rates of substance abuse and dependence that stress seems to generate. It doesn't help that it's so damn easy to, for example, divert narcotics. (I've borrowed that phrase. I hope that's ok, and I hope you don't feel I'm making light of this. I've already touched on the damage booze inflicted on a good friend of the Shroom)
In this specific case, I think my first draft of the post in which I started this was written badly. But I am concerned about a colleague. I've spoken with X, and there is a lot more going on than I thought. In a very real way, it's none of my business, and I hope people will understand if I don't elaborate further. In another very real way, it is my business. We have to look out for each other, right? If the Shroom was in trouble, he'd want to know folks were looking out for him. I have gained some reassurance that drugs do not lie behind what was worrying me. I hope I'm as right this time, as I was wrong before. I'm sure we've all seen how easy it is for something to spiral out of control, and end up the dominant, destructive force in a life.

Drugs are bad, m'kay?

---A bit more maudlin navel gazing.

I occasionally find myself contemplating my place in the world, and who I'm sharing it with. Which is no-one right now. This is fine by me, most of the time. A fella's gotta be happy in his own company, right? Well, maybe, but just at the mo' I'm lonelier than usual. In my first (draft) post about getting yer ya-ya's out, it was this I was referring to, crudely, when I wrote that I wasn't getting any. (Classy - Ed.). Not the drugs (still classy - Ed.), in case you were thinking I'm more degenerate than you had at first guessed. I'm still fighting off the nicotine, and can do without another addiction, thanks.

So, I'm footloose and fancy-free, but a bit miserable with it. But I could probably get my ya-ya's out, at a push.
Well, today, I set out to rectify the situation. The Shroom has been sweet on one of his colleagues for a while; we don't work together all that much, the shift system being what it is, but we were on together today. Now was my chance! Those who know the Shroom will not be surprised to discover that he deployed his usual charm , and flailed about, failing to broach the subject at all. However, I did find out my mission was a lost cause, after she'd gone home for the day, by discovering she's already seeing someone. I'm fairly certain I managed this clumsily enough that she will already know I was asking about her.
So: to summarise, no date, and I managed to make myself look clumsy and gauche. (Result! - Ed.)

--- Final minutiae of The Shroom
You can see what I'm listening to, so to complete your multimedia profile, I'm reading Redcoats by Richard Holmes. If you're so inclined, you can pretend to be in my head.

I'm not sure I recommend it right now.

A Light Interlude

Befor the return to 'heavier', more depressing gibber, a little light relief, with help from our friends at YouTube.

More Stag related nonsense

Sex, Drugs and Getting Yer Ya-Ya's Out

The edited version. Part the first. The drugs.
One of Shroom's colleagues has been concerning him. X is increasingly prone to mood swings, and sometimes seems irrational. I have an idea that X is using opiates - maybe just codeine or tramadol - for their occasional euphoric effects, rather than their analgaesic efficacy. Morphine is very easy to come by in the ED. It would be a relatively small jump... or an huge one, depending on your perspective. Maybe I'm over-excited. I know my duty lies in confrontation if my fears are that strong, but I don't want to charge in. Maybe something else is going on. I shall talk to them. Simply voicing my fears here isn't good enough.
I'll let you know.

The Summer Had Inhaled, And Held It's Breath Too Long

There was supposed to be a part the second, and indeed a part the third yesterday, but technical difficulties intervened.

---Anyway; what had been on my mind was continuity of care. This has had the habit of picking up controversy from time to time. Like fluff on your favourite shirt, if you will. Mostly because some people think patients used to get it, and that they don't anymore. Either way, Emergency Medicine has never been about long term continuity of care; and this fact holds much of its appeal to some people. Such as your resident fungus. So it is in that context that I say I don't much care for it. I enjoy avoiding ward rounds and clinics as much as possible.

---However, it is occasionally nice to see what has happened to memorable patients that pass through the Department. Now, obviously, I care deeply about the fate of every living thing I encounter, but some I am happy to trust to my erudite colleagues in the rest of the hospital, and others I try to follow up myself. Either to see them and wish them well, or to see what the blue blazes was actually wrong with them (which can, of course, allow the occasional smug(implied) 'I told you so' to be floated)... as in:

Shroom: Ah, hello Mr Surgical Reg

Reg: Shroom; aren't you an A&E weasel? Why have you darkened the doors of my surgical shrine? I mean, ward?

Shroom: Just checking on Mrs Abdo Pain from yesterday. You know, the one you said had a UTI (urinary tract infection)

Reg: Turned out she had an aneurysm. We opened her last night.

Shroom: Aneurysm. My goodness. Gosh. Didn't someone suggest that yesterday... I could have sworn they did...

Reg: **grunt**

Shroom: No. That's right. It was ME! I said 'I think it's an aneurysm' and you said 'Fuck off, is it'; or something... well, fancy that. Funny how things go, eh?

I am perhaps a little less direct, but, I suspect, often just as annoying.

Sometimes, I think it's better not to know. The fella I saw last week who'd come off his bike, with two smashed knees has been waiting days for transfer. At the time his partner asked if he might lose a leg. Having seen injuries like these before I had to admit it was possible, but, rather foolishly tried to downplay the idea. Privately, I felt sure he had a high chance of ending up with at least one amputation at some point, and the longer he waits for definitive surgery, the more debridement that goes on, the more likely this seems.

After what seems like months of driving rain, and flooding throughout the country, I was delighted to hear today that my local water company up London has finally lifted the hosepipe ban. The irony is almost killing me.

---A couple of funny old cases today. The weather was again dominated by gales and driving winds - gusting around the 90 -100 mph mark they tell me. This is more than enough to knock over pensioners on giro day. However our first was a fella who fell off a roof, trying to rescue a cat. Despite looking as if he had sustained multiple injuries, I couldn't find a damn thing wrong with him. We admitted him anyway, in case there was something lurking (I particularly distrust the retroperitoneum. I would advise you all, especially those in the legal profession, to make this top of your list of Body Cavities You Don't Trust. It surely tops mine.)

The second was an older lady, who despite looking well enough from end of bed, I couldn't find a damn thing right with her. She is one I'll follow up on...

If Songs Were Lines In A Conversation, The Situation Would Be Fine

Part the first... events on a stag night.

Things you least expect to see, having staggered into the night on a cold Saturday Morn...
Naked Rickshaw Man!




I think he's getting some cash out.



The only sensible response?

Pure Tomfoolery!

So, you must have gathered there's not a great deal of medical drama in this post... It was one of The Shroom's good friend's stag do this weekend. The groom to be had initially been reluctant to engage in anything too elaborate. Of course we ignored him. Dinner and drinks on Friday night, followed by hangovers and shooting on Saturday morning. Most of us had to have a siesta after that, which is frankly shameful. The ravages of age and whatnot. Then, dinner and gambling down at the Dogtrack... I think everyone but the Shroom and the Best Man won at least once. The Shroom had the knack of picking the dog that came in second, but not the sense to bet on them to place.

The Bottle of Shattered Dreams

(---losing tickets to the rest of you)

Despite his reservations, I think the Boy had a good time; and he won the shooting... despite us having a bone-fide Army man among us. (But he would want me to remind you that he deals mostly in area effect munitions.

Having exhausted our minds and bodies on the fields and dancefloors of the city of dreaming spires, we returned to our Hotel, to find it in full swing. Some company was having a function there, and I have rarely seen so many drunk people liberally scattered about a building - not since Med School anyway.

A special mention must go to the naked man I saw roaming to corridors at 0330hrs pleading desperately for a condom - "for the love of God, someone must have a rubber?!?"

I really felt for him...

Bunch of halfwits, with shotgun

I'm too hungover to write coherently today, hence the pictorial posting.

An unusual present for the one you love

Please be aware that the above will offend you if you are a prude, or have a mature sense of humour...

I couldn't have said it better myself (2)

Read this... I dare you

Pride Cometh Before A Fall... and all that jazz

I have had it in my mind to write a long soul searching post about the meaning of life, love and all the other shit that we spend our short time worrying about. Time keeps getting in the way. I will go back to that later, if only for my sake. It's something I need to get of my chest.

++++++++++++++++++++++++++++++++++++++++++++++++++++++

I've had an odd week. Work is beginning to pile up on me at the moment, and I'm spending far too much time procrastinating. Those who know the Shroom will not be surprised. It's quite nice to think that your bosses trust you enough to give you work, but very difficult to refuse. My various assignments are by no means un-do-able... but I'll have to change my lazy-ass ways.

Had a few beers with an old friend recently. This was nice, because he was once one of the Shroom's best friends, but I had a silly falling out with him a while back, and soured the friendship, a lot. We can never go back, and I'm not sure he was ever as much of a friend as I thought - and I guess you could argue that I wasn't much of a friend to him - but it's still good to be hanging out with him again. We had an interesting chat about vanity. But more of that later too, I think.

Interesting radiograph of the moment:

Look closely... It would humour me if a few of you didn't see it right away, either...

The poor fella above came in having had a fit, complaining of painful shoulders. I know. It's textbook. But we hadn't cut his shirt off; AND they weren't tender; AND his pain was actually worse in his elbows... but I missed it, plain and simple.

When I finally did spot his bilaterally dislocated shoulders, he and his family were quite reasonable, considering I should have seen it 2 hours previously. I guess they were just happy to have a diagnosis (for the arm pain, anyway) and a treatment plan. He's doing well, by the way.

This evening has mostly been occupied by a nasty motor cycle accident.

I'm afraid he's due for a painful few months. His arrival really set the tone for the shift. The weather has been super shite, all day; I was unpleasantly surprised to discover the storm forcing its way in through the vent in my bathroom. It isn't everyone who wakes up to a raincloud in their shower. The weather seems to have kept most people at home during the day (when I was also at home, asleep). But it improved a little by the time I came on shift. Improved enough for them all to stream forth and slip on stuff, breaking other stuff.

I'm hoping the rest of the night will be quiet. I'm off to London and Oxford this weekend, for a Stag weekend (providing the storms haven't fatally damaged my house.) Reports to follow on Monday.

As for other minutiae of Shroom's life: I've weaned myself off nicotine, so far without going completely bananas. I am snappier than usual. I'm up to season 6 in my epic ER-a-thon.

I'm starting to become obsessed with who's reading this, and how many times. I have found myself checking blogrolls, and linkmeters. I do not think this is healthy. I am going to try and stop. I will limit myself to a simple counter ( I can give up, any time I wanna, honest...) For you who do read me, thanks. I started this to vent my spleen and as a cathartic; to try and ease my histrionic soul. I did not do it to be famous and or popular. If my ranting is to your taste, please fell free to spread the word of Shroom. But please help me not to get obsessive or big headed.

This Is Your Brain On Drugs...

It's amazing what a little speed can do for you...

Whatever your position on drugs - draconian, liberal or ambivalent - it's always worth considering just what the final price for a quick rush might be.

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For the non-medical of you who have stumbled into this page, these are CT scans of a brain. The grey stuff is brain, but the white cauliflower-y thing on the left of the image is blood. And plenty of it. And not where it should be. In fact these images graphically demonstrate number 2 in my list of "Places where you don't want your blood to be"

(Number one is 'all over the floor', but I am willing to reconsider the ranking, if anyone feels they have a contender)

Jack the Cat

Because I can't think of anything to write about today. And it's not everyday you see a bear cub treed by a cat.

What your doctor got up to in med school...

Gimme Shelter

And the beat goes on...

I see that it's becoming almost de rigeur for a story to be published daily documenting to horrific slide into oblivion that the once mighty NHS is undertaking.

Was it ever really as mighty as we think? My recollection is always of a service over subscribed and abused; that the Tories can now paint themselves as the party of the Health service, after years of Thatcherite neglect, beggars belief.
Maybe we were once great, but we sure as hell aren't any more.

---How can anyone think such a massive organisation can be managed centrally?

---How can anyone still not realise that free health care costs a shitload?

---Why aren't we doing more to stop the Government ripping the guts out of our system?

Morale is in danger of bottoming out, and this administration seems intent on providing health care that is cheap. Which sounds good, until you stop to think that that is apparently their only criterion for success.

And cheap does not equal good.

It fills me with rage that there seems to be a pervading thought that the job that Doctors do can be broken up and provided piecemeal by various non clinical specialists. What's worse is that all we seem to do is complain (natch) about it.To top it all, I now understand that a significant number of us will be "surplus" by the time I'm looking for consultant posts.
This is ridiculous. How is it cost efficient if the Govt spends money on training me for ten or twelve years, and then I fuck off to another country because either there's no job, or it turns out I don't, in fact, like being treated like an halfwit?

I truly fear that the NHS has become so rotten to its very core, that there is no way back for it... at least not in a form that Pa Shroom would recognise.

--Rant interrupted--

As a follow up to my ranting about training, I've been thinking about trying to clarify my position. The divide seems to be between those who want a life, and those for whom work is life. Work to live vs Live to work .
I'm increasingly in the latter category. I'm not saying this makes me big or clever. In fact, I can't help but suspect the exact opposite. But it is true. Every major decision I've made since I was about 18 focused on my career.

Why can't these two tribes co-exist? There surely is a macho culture associated with how long you work, but if you don't buy into it, that's fine. There's always someone, somewhere trying to prove his balls are bigger than yours.

I don't think working long hours has made me a better doctor than you; but it has made me a good doctor, and I firmly believe the experience I gained working long sleepless shifts has given me confidence and knowledge I would otherwise lack.
Sadly most of it is surgical, and so not very applicable in the ED under the bootheel of the bitch Hewitt.

But I know it's not the only way. And I'm sure plenty of excellent Docs out there have enjoyed shorter hours and fuller lives.

Is there a way..? maybe not.

If you don't already own it, I commend Let It Bleed, by the Rolling Stones. Your life will be immeasurably poorer without it, in ways you can't even imagine.

It feels like somebody's sticking me with a knife, doc...

Make of it what you will...

Five Live Yardbirds

Back again.
I have it my mind that there's plenty to tell, but that it keeps slipping my mind. In my version of reality, I regularly imagine my occasional readers struck by how informative my posts are, or gasping at my rapier-like wit. Please don't disabuse me of this fragile charade.

While I was on holiday, I was at a friend's house having Christmas drinks. This year seems to have marked a watershed of sorts amongst my friends, as we now 'do lunch' or have people over 'for drinks', and it's all very civilised. I'm guessing we're trying to convince ourselves, and anyone watching that we're grown up now. Personally, I'm not fooled. Anyway, towards the end of festivities the doorbell rung, and was answered by the host's brother-in-law. A young woman came in, waving hello to one and all. She made it about half way to the kitchen before she came back to do a double take. She was in the wrong house. Brilliant. Apparently it was only that the walls were the wrong colour that tipped her off. She was undaunted by not knowing any of the guests. Very social I guess.

See, I was right. It's all slipped my mind.

I've seen a few posts about junior doctors hours recently; this is enough for me to throw my tuppeny's worth into the ring.

This eternal problem is forever rearing it's ugly head. Old school doctors worked long hours as juniors, got very good experience and an unrivalled breadth of knowledge. The current generations work less hours, and resent hearing endless "in my day" stories, from grumpy bastards like me. In this country the European Working Time Directive has had the final say in the matter, although in many cases people still work over their hours; they just don't get paid.

Personally, I think we should work longer hours as juniors. Someone's got to work the hours, and trying to employ more doctors to share the load is bankrupting the NHS, according to her holiness Patsy Fuckwit. Less hours as a junior means more hours as a senior, and less experienced seniors. I'm sure the policy is short sighted. There is also, it seems to me, an effect on continuity of care. Pa Shroom marvels at how the surgical service has changed since he first started at Shroomville General. Then there were 3 consultants, 3 registrars and 3 house surgeons. Now, the hospital has been down-sized, so there are less beds, but somewhere between 30 and 40 on the surgical staff.

I have had to field questions from house surgeons such as "how do I give an injection?" (Although I hope this level of lack of knowledge is rare)

It seems to me that a person needs a certain number of hours experience to be a good consultant. So less hours per year equals more years training. Although the government's idea id to shorten training. The choice may be between someone who is well rested, but doesn't know what to do, and someone who is tired, but does know. Yes it's unpalatable, and the idea that people should train in a certain way because their predecessors did is unacceptable.

But long hours seems to have produced good doctors. I'm not sure shorter hours and less training will.