Tuesday, September 30, 2008

Folk Music Re-'Imagined'

Buy the album, see them live... do it. You know you wanna...

Odds And Sods


Struggle on, trying to finish some work related research, revise, generally live my life. It goes slowly; I think I'd be good as a sloth. Although not sure I'd pass the entrance exam.

La Belle Fille continues to understand, which is good of her; spent the weekend hanging out, which is good for the soul; I also had the pleasure of seeing possibly the world's biggest round of cheese at the local French market. God love the French.

A brief flag for NotDrRant. This blog has a very different spin on the NHS; a patient's view, and not a complimentary one. I'm in favour of free speech, so you should feel free to check them out, tho' I don't hold with their take on the causes of the faults ( to whit, it's all the doctor's fault. ) That having sad, the author doesn't seem to have been served very well by the NHS.

It raises at least one interesting point. (For a certain value of the word 'interesting') While patients can, almost without fear of censure or repercussion, write what they want about the medical profession, or indeed specific members therof, the medical profession has little, or no, right of reply. So, there is little to stop Mr Smith naming me as, for example, "a cunt", for all the world to read. But if I name Mr Smith as, for example, a wife-beating kiddie-fiddler... the Law has me by the balls.

On balance, I'm in favour of confidentiality. Publishing lists of naughty people all too often results in hysteria, and Paediatricians having their houses shit-bombed; but shouldn't there be some sort of quid pro quo? As a medical professional, I must be completely transparent; I accept this. I must also be inscrutable; I accept this, too.

But should there be some sort of checks and balances to stop my being compared to reproductive anatomy?

Surely Shome Mishtake...

You are a

Social Liberal
(75% permissive)

and an...

Economic Liberal
(21% permissive)

You are best described as a:


Link: The Politics Test on OkCupid.com: Free Online Dating
Also : The OkCupid Dating Persona Test

Monday, September 29, 2008

Bloke In A Dress

Casually, and swiftly, photoshopped by a good friend of mine.
I should add that the Shroom does not consider kilts to be dresses, skirts, or, indeed, anything other than manly clothing, especially whn worn 'Highlander', as both I and the Groom were.
I also have nothing against blokes wearing dresses. All power to all people, that's what I say. In fact, it's quite liberating, as long as yo remember to keep your knees together, and avoid scaring children / being placed on the sex-offenders register...

Gratuitous 'Skirt' Shot

Friday, September 26, 2008

God's Dandruff

Continue in low mood; it is what comes of spending long days alone, at home, ruminating on my own inadequacies.

My impending exam - the Fellowship, the exit exam, the big one... what it takes to be board certified, I think, if you're one of my Colonial brothers or sisters... dwells heavily on my mind. I've spent the last year pretending it was an age away; and know it isn't. I'm not sure where the last year has gone; it seems to have slipped away from me.

There must have been something on my mind (at least for the last 6 months).

Caught a programme on the Beeb a few days ago, about the birth of the NHS. 'Twas interesting, if only to hear the concerns of the (largely) middle class docs regarding the State control of medicine. That the doctor would no longer work for the patient, but for the state. That there would be no autonomy.That we would be told what sort of medicine to practice. Told what we could do and not do, say and not say.

While the GPs were against it, Bevan swung opinion through the influence of Lord Moran, President of the Royal College of Physicians; not by much mind - he only won re-election that year by 5 votes.It wasn't clear what role Surgeons had in all this, but I'm guessing that they too were amenable to having their throats stuffed with gold...

The objections seem to mirror those I see expressed by my Colonial brethren today, when threatened with Socialised medicine, and indeed they would seem to be (at least partly) valid... what was prophesied has indeed come to pass.

Is the NHS a good thing?

Fundamentally, yes it is.

I can't not believe that. People don't die because they can't afford to see their doctor anymore, childhood disease is a shadow of it's former self, and is only really coming back because of the gullibility, stupidity, superstition of certain sections of the populus, encouraged by the media.

Is the Continental system better? The American system? I suspect the practitioners thereof would tell you "yes", but, and I think there's some evidence out there to support this idea of mine, I'm not sure they offer better results per unit spent.

But maybe all that proves is that spending more equals better care... up to a point - see the way China works. But maybe I just don't know any better.

And a man can become little more than the sum of his ideas, his obsessions.

Get it right, and you're a genius. Wrong, a crackpot. We need to be careful about being defined by our own horizons, our own experience.

Consider the American tourist visiting the Bodleian Library in Oxford. Much impressed, she enquired of one of the Security Guards: "This place looks so old. Is it pre-war?"
With a haughty sniff, the Guard drew himself up, puffing out his chest."Madam", he replied, "it is pre-America..."

Does that fit a pre-conception? Should it? Is there any mileage listening to the ramblings of a man who thinks the height of comedy is a Gorilla drumming?

Thank you for bearing with, constant reader. Sometimes I just need to let the mind wander.

More sense soon.

(Or possibly just a picture of me in a kilt...)

Friday Random

If there's a better way to advertise chocolate, I don't know what it is...

Wednesday, September 24, 2008

Nights Drawing In

I continue in low mood; the 'Black Dog' and I always seem to end up struggling about this time; I suppose if I wanted to, I could call this Seasonal Affect Disorder. It always seems to coincide with the shortening of the days... but, not only do I dislike what I consider pointless labelling (see: IBS; CFS; Fibromyalgia...), but I actually enjoy this time of year; I enjoy the cold, crisp nights and mornings; I'm not quite so keen on getting up, and going home in the dark, but...

I think it is just overpowering nostalgia. Some of my happiest memories are rooted in these months; and I think it just serves to remind me how far I've travelled from them. I miss my friends and my family increasingly these days, and all the more so at this time of year. This year, my mind is troubled with impending exams, and the amount of work I haven't done - some things never change, I guess.

I think this is especially hard on La Belle Fille, who works as hard as I do, for less money and with considerably more organisation; so she finds it hard to see why I should be so stressed, and hard to find ways to help me. And she finds it hard to put up with my bleak moods; the stress isn't good for our relationship, which already labours under the constraints of both our jobs. I know she reads from time to time, so hope she'll manage to put up with my increasingly monk-ish behaviour over the next few months.

Name in lights...

Tuesday, September 23, 2008

Ever Wondered Why They Called Him "God"?

The sax solo ain't too shabby, either, but nothing beats Eric's guitar face....

Things That Make You Go 'Why?'

Hat-tip to Kal at TQ.
Further details to follow, especially involving La Belle Fille, who was heard to complain that her 'character' appeared to have been written out...

Tuesday, September 16, 2008

My Promises Are Nearly Kept

Saturday was unbearably busy; Sunday just unbearable. It was busy, I was irritable. The SHOs are hard working, God love 'em, but have a deal to learn about the appropriate time to strap on in Emergency Medicine. I'm not sure I helped much.

The tone was set, not so much by Drs Greene or Carter, but by two patients. The first, a young man with his own version of a biological clock; his aorta distended, over-ripe lay swollen and pregnant within him. He knew it was there and had had the 'full and frank' discussion with his surgeon. Weighed the odds of success against the chance of failure and the consequences inherent therein. He had, he thought faced his demons, made his choice, and defended it. The ultimate act of self determination.

Funny how circumstances can change a body's perspective. Each man faces death alone, and sometimes it hurts. He faced death in the company of us all, and asked for one more roll of the dice. We gave it gladly, some less calm than others, but we stood by him.

Snake eyes is still snake eyes, no matter how many hands help roll it.

Number two had other gifts, unknown, only now bearing fruit; spoiled and rotten; foul and terrible. Still I bore them, my words harsh even under the bright lights of the ED. My words, short, to the point, still have the power to bring tears.

Still, the next will be better, eh?

Sunday, September 14, 2008

Knifeman's Blues

Shall I whisper to thee of the nights I have seen...

My nights are full of coffee and hope; hope for a quiet life, and yet hope for a chance to show off and do my job. It is an interesting dichotomy - I enjoy seeing the big cases, treating the really sick guys and gals... but it means someone has to be sick...

Quiet? Or busy? I know which I prefer, but it's for selfish reasons.

Shall I tell thee of the ways the nights begin?

Heading to my car, I realise it's dark, and with a slight chill in the air; I have blinked and missed summer. Actually, the last year has been something of a blur, but I was counting on summer. Driving to work, I feel cocooned in my car; isolated. I try to use the time to prepare for the joy that is too come. Sometimes it works.

Shall I tell of the tells we see?

The first is the ambulance bays. If they're full, and especially if there are plenty of Police jostling for position, it bodes for an... interesting night. Resus is next; I see it as I come in the ambulance bay doors. Last night it was humming, full of eager doctors, jumpsuited road warriors and coppers. A stabbee and the stabber all in a messy package. The first 3 people I see advise me to turn about and run, before it's too late. The next is the Charge Nurse - he asks m to start early - 'becaue we're a bit fucked'.

It's going to be a fun night.

Friday, September 12, 2008

Benign Tremor

I recently discovered someone lit upon this blog while searching for advice on how to treat a torn frenulum (or "penis banjo string" as he - and I assume it was a he - put it.)


Try pressure and hope it stops, cos you really don't want a stitch in the old fella....

Regarding comments made to this blog - it was never my intent to embarrass; just to let you know really. anyway, there it is.

I'm seconded to Paeds at the mo, altho' I still owe the ED my nights and weekends, so am trying to spend all of my time among the little people. It has reinforced in me the desire NOT to be a Paediatrician. Don't get me wrong - I love kids, but lack the mental strength to deal with them suffering on a regular basis. When kids go off, they do it properly - fast. Kal, over at Trauma Queen, writes about this, and the effects it has. He's also lucky enough to have seen that they come back up quick, too; but sometimes they don't, and I find that very hard to deal with.

So far, its mostly been wheezers, but I have got to go on a couple of transfers, which is always grand... provided nothing goes wrong.

Occasionally, I find myself wondering at how my entire speciality is basically dependent on the fact that shit WILL go wrong... someone's gotta do it, I guess.

Mind how ye go, now.

Honesty In Advertising?

Thursday, September 11, 2008

The Love Of Money...

So, today, I both read, and heard on the radio of the hardship QCs are being forced to endure. The new minimum rate of legal aid work is a paltry £91/hr, rising to a max of £145. The say this is risible, especially as they reckon half of the cash goes on overheads and taxes.

By my reckoning, if I earned £91 an hour, and took home half, I'd clear almost 9 grand a month, and more like 14 grand at the higher rate.

Poor bastards; how do they manage?

(Incidentally, they say that the lack of paid holidays and pensions makes the rates reasonable; to be on my take home, which, let's be honest is not to be sniffed at, I suspect they'd have to be paying 90% of their gross in taxes and pensions and unpaid hols... on balance, I think I'd take their pay and terms over mine... if I could find a lawyer who'd trade...)

In Case You Were Wondering...

Comments get e-mailed to me.

Tales of derring-do from Paeds to follow...

Saturday, September 06, 2008

Musings Of A Medical Dinosaur

A work in progress.
Worth reading, to start with.

The wind is changing; has changed. Jane Doe, writing the jib I've tagged above, typifies what I have come to think of as the 'modern' attitude. Respectable papers in such august journals as the Annals of Emergency Medicine are chronicling the decline of the once mighty General Surgery. In part, this is because specialisation makes being a generalist difficult, but, and perhaps this is the greater part, also because no-one wants to work the hours.

Long hours, once seen as the domain of the macho surgeon, are no, it seems to me, increasingly seen as both unnecessary and unfair. Many young Docs, confronted with the sort of punishing shifts once common in the NHS were taken aback. It was not what they were expecting. I must confess I find this hard to credit; it was hardly a well kept secret, and many medical dramas made it a key feature - see The Houseman's Tale, Cardiac Arrest or even ER for reference. Perhaps I write from a privileged position; Pa Shroom was in the business, so I saw the routine 12 hour days, and 1 in 3 (1 in 2 when someone was on leave) he worked - and this as a consultant.

I knew exactly what sort of hours I would be expected to put in.

But if you weren't sure... surely it wasn't that hard to find out..?

The way I see it, the way I saw it... you worked all the hours God sent when you were young, and I will never be that young again, and it got easier as you got older. I was always at work earlier, and later than either my SHO and Reg; I'm sure they worked harder, were cleverer... but I worked as long, if not longer.

Was I tired? Yes, all the time. Did I make mistakes? I'm sure I did. My shroomy pride has blotted the copy-book of my memory clean, but I know I didn't kill anyone. Did I learn anything?

Almost everything I learned, I did on call; often in the darkest hours of the night, often in desperation. Was this the best way to learn...?

I can't say that it was, that it is. I'm sure it's not, but it worked for me; doing my time pulling scut duty taught me the basics. Some might say that putting iv lines in, mixing and starting iv drugs isn't real doctoring. It certainly ain't glamorous, but it's as much the duty of a doctor as anything else. And what happens when the iv techs aren't there, or can't get it?

They call me, or other grumpy bastards similarly full of themselves.

Continuity? Sure, you can never have absolute continuity, but it seemed to work better. It was the exception, rather than the rule that someone on the firm was away, and we all knew all of our patients.

Is the way I learned better? I don't know, but it did work for me, and I know I'm not alone. Is that reason enough? No. To say 'I did it this way, so you have to too', is blinkered.

But it shouldn't be dismissed out of hand either.

On Censorship

BBP hints at some skullduggery in the ED.
I like him, I enjoy his blog, I enjoy working with him; he is good at his job.

I am curious to know what has been afoot. I have been off the floor working with small people again, so can't speculate.

Freedom of speech. I'm a big fan; censorship is a bad thing. It's next to book burning. And yet... there must also be limits. Right? Does freedom of expression extend to someone who wants to come to work andshout obscenities at me? In general, no. I'll have him removed.

If something goes wrong at work, should it be public knowledge. There must be transparancy, but do people need to know everything? If you hide something, no matter how small, is it the first step down a slippery slope?

I think maintaining the moral high-ground is difficult. If I make a mistake, I'll own up to it. That's the way it should be, but I'll bet I could find an exception, one situation in which I could justify, if only to myself, bending the rules.

Ethics. Not just a county somewhere in England...

Wednesday, September 03, 2008

Son Of A Sunweasel

I know, its basically bragging. But it's nice to feel appreciated once in a while...

Jiggling Like Hopeful Ducks

See this. And this, the original.

A veritable foaming sea of bilious ranting. Nurse K has much to say on this, as ever. It's worth reading her blog, even if you don't agree, though it might push your blood pressure up.

The truth, I suspect, as ever lies somewhere between the two extremes. Migraines are ever a hot topic. I'm faintly curious that we seem to suffer the problem of the migraineur who may or may not be drug seeking less in the UK than in the US. Or do I just see less of it. Or maybe it's because we don't give dilaudid for migraine. I think, but feel free to offercorrections, dilaudid is pethidine. I used to dole that out like sweeties to old ladies with broken hips when I was but a young fungus. Now, I'm given to believe it doesn't work so well as a painkiller, but does get you off your tits.

I don't see much comment on this matter in the US blogs. Specially not for the patients who say it's all that will treat their pain. Put yourself in my shoes. When someone asks for a drug which, as I understand it, has no more analgaesic potentcy than, say, morphine, but does get you high, what should I think?

I'm sure it relieves your symptoms, and makes you feel better... but booze does that for an alcoholic. I haven't seen many posts advocating my prescription for Tennants Extra on demand.

I should declare a conflict of interest:
--- I don't believe in certain medical conditions, fybromyalgia, among them
---By which I mean I believe in your pain, I just think it represents a failure of coping mechanisms
---I don't believe narcotics prescribed in the ED are apt ways of dealing with these conditions

However, I recognise that this doesn't give me the right to dismiss your complaint. Just cos I don't believe in a medical label, don't make me right - plenty of folks didn't believe bacteria might cause ulcers. Plenty of folks don't buy into the theory of evolution through natural selection.... vive la difference.

I also recognise the need to spend more, not less time making sure we don't miss anything on the 'frequent flyer'. One of our regular attenders, a fella who for years laboured under the effects of his excess alcohol consumption, who for years was managed more on the basis of his past than his present was recently diagnosed with a malignant tumour. Did we miss it by dismissing his claims - "drug-seeking"; "pisshead"; "always doing this"?

I don't think so; I hope not, but a timely reminder that the boy who cries wolf daily is sometimes being chased by a big fucking dog.

Do we lack compassion? Sometimes, despite our best efforts, of course we do. It was said of Napoleon's Surgeon that he was the 'least among men'. Good practitioners sometimes lack people skills. Or does this automatically disqualify them...