Wednesday, September 30, 2009

Entry Redacted

With satisfying timing, LBF contacted me today to express some concerns about the details included in the episode in which Schlingo made her debut...

I should therefore make it perfectly clear that I know teachers, of all varieties are highly skilled, overworked, underpaid pillars of society. Their work is much more than colouring in shapes.

Sometimes they stick the shapes on bits of card afterward.

Suffer The Little Children

Considering I spend all day dealing with people, I occasionally find them surprisingly annoying. Sometimes, I might suggest, this is well deserved - the pisshead who thinks it's funny to take a crap on the floor, for example. Sometimes, I think it's probably futile. People are the way they are, and I'm not sure i can blame them for that, any more than I might scold a cat for eating a mouse.

Children, specifically teenagers, and their parents are among the leading perpetrators.


If you think you are old enough, are mature enough to get drunk, go skateboarding au naturel, and then fall on your head, you should be mature enough to accept that your treatment will have to be in hospital, that a cervical collar is a bit uncomfortable (tho only for a bit, and much less uncomfortable than 60 years as a quadraplegic...) Instead, you will whine incessantly about wanting to go home, about how there can be no needles involved in your treatment. This last is despite your multiple piercings.

And this makes me cross, but perhaps it shouldn't, because my attempt at logically suggesting that your decision that you're mature enough to get drunk and arse about isn't made because you are mature, but precisely the opposite; and so when you act like a scared child, it is because that is what you are; and I can't blame you for that, can I?


If you're child gets run over while in the charge of another child, and if she bears the insult of a fractured femur with quiet dignity while you fret about how you didn't see anything, and sway from side to side, smelling faintly of drink, I can't help but feel slightly aggrieved, if only on behalf of the child whose leg we will soon be pulling straight. But maybe it's too much to expect you not to drink, and to supervise your children crossing busy roads. The Green Cross Code Man has gone the way of C90 cassette tapes, so who does teach kids road safety? Maybe that degree of responsibility is just beyond you.

If you take your child to a party, and they get drunk, so drunk that when you bring them home they become belligerent, shouting abuse at you, breaking your lamps, it surely isn't really your fault that you can't cope. If that level of common sense, or emotional maturity is beyond you, I shouldn't be surprised it's beyond your growing offspring, and it really is unfair to be cross with you...

After all, shit does happen, eh?

Tuesday, September 29, 2009

One By One

South Coast General provides pathology, thick and fast. One by one, sometimes all at once.

Today's shift provided more good evidence that empiricism lets you down. A fella came to us, pinged ahead by the MobiMed, a computer link up with the Ambos, allowing them to flag patients and their ECGs. Telemedicine, I guess we should call it.

It offers real time comms with the Ambos, and sometimes, the opportunity to see the poor buggers go off, en route, in real time. The first message forewarned of a patient with a headache and left-sided weakness. Otherwise, stable, so far, nothing so unusual, unfortunately. Within minutes, they pinged back. His Glasgow Coma Score had dropped to 5. This is a score ranging from 3 (which even a corpse would score) to 15. 5, you can deduce, is bad.

Minutes later, he had dropped to 3, and was fitting.

He was still fitting when he arrived, and the thought going through all of our heads was one of a head full of blood. Haemorrhagic strokes, or intra-cerebral bleeds produce cerebral irritation, and, in my experience, often result in seizures. The outcome is always bad.

We stopped the fits, relatively straightforward, and prepped him for the CT scanner, anticipating the dread images that would allow us to decide his fate. The family were unprepared; they always are, to varying degrees. This family, especially unprepared, left devastated by my visit, sold an awful bill of rights by my 'pep-talk'. It's hard to offer hope when you don't believe here is any.

Whilst he went to the scanner, the Department coughed up its next surprise - a woman described as 'normally fit and well', looking as far from those words as I've ever seen. To start, she was the very definition of morbidly obese. Her BMI approached that of Tonga, and any skin that wasn't parchment white, was mottled purple. Apart from her eyes, bright, and frightened, she could have been one of our failures.

The only history, from her niece, was of abdominal pain. Her belly was ice cold to the touch, and firm. I was sure her abdominal wall was rigid, the hallmark of peritonitis, a diffuse inflammation of the lining of their abdominal cavity. This can be caused by many pathologies, all of hem highly undesirable. Intestinal perforation, for example.

I don't wish to blind any of you with science, but having a belly full of shit should be high on people's list of things to avoid happening to them. This woman looked as if she'd been harbouring a belly full of shit all week, and was just about ready to give up the ghost.

To be fair, there was some debate as to why she was so ill, but actually, when you're that sick, the exact cause is, probably, somewhat moot in the initial phase of resuscitation.

Either way, I had now managed to stack up two families, next door to one another, for whom I represented their worst day. Families united in grief, never further apart.

As it happened, the first chap's CT wasn't as bad as I feared, although I worry this will only prevent the inevitable final delivery, and the second showed a belly full of pus, not shit.

Worth trying to keep track of your tampon, it would seem...


Women are... interesting... make of this what you will.

When I first wrote about LBF here, she phoned me up to complain; not unreasonable, you might think, since I hadn't let her know she was going to feature, and some folks don't want their comings and goings splashed on the 'net. However, this is, after all, the ramblings of a grumpy old man, not The New York Times, and mostly anonymous(-ish), so one might argue few people would either see it or recognise her.

So, her entry was removed.

It seems that the only thing worse than being talked about is not being talked about, and LBF now regularly mentions, just in passing that her character has been disappointingly quiet recently.

Now it seems I have to expand her character and provide more back story.

LBF need more companions to keep her company when she's not having adventures with me.

And so I have the pleasure of introducing Schlingo, LBF's comrade in arms. She, too, is a teacher, and lives downstairs from LBF. She teaches younger kids than LBF, and I suspect they both think their job is a little bit harder than the other's.

I think its all basically colouring in shapes.

(This may not be the kind of storyline Schlingo was hoping for...)

Anyway, in case you were thinking Schlingo is a kind of two dimensional charactwer I've invented, to give her depth, it's worth noting she's dating JazzMan, who comes from the 1930s; or 1950s, depending on who you ask. She also once described yet another of LBF's friends as looking like 'an angry blue smartie', and suggested that Susan Boyle looked like a 'haunted tree', proving at a stroke that she has a far greater gift for language and imagery than I could ever hope to.

Anyway, she wanted in to this merry soap opera, so here she is.

Welcome aboard, Schlingo.

Tuesday, September 22, 2009

Giving It All You've Got

One of Shroom's tricks manifests itself as pessimism. I prefer to think of it as realism, but it's really pessimism.

My reasoning runs thus: many of my patients will be in extremis, and I may well know their fate before they do. Worse, it may be obvious that, no matter what I do, the outcome will be grim.

So I try not to get my hopes up. This is not to say I don't go Full Tilt Kozmic Boogie, where it's apt, but thatI steel myself to the idea that despite it all, they're going to meet their maker.

It just hurts more when you invest a bit of your soul in the belief that they might just be ok.

Maybe this makes me less of a human, but that's how I choose to cope.

For example: a few days ago, a fella arrived, clapped out, with a history that screamed 'ruptured aneurysm'. A man of middling years, with belly-ache suddenly worsening, crashing blood pressure and fluctuating conscious level.

When he arrived, he genuinely was pale as a sheet.

That should tell you, as it did me, that he was only ever going to leave Hospital by the back door.

And yet...

Full Tilt Kozmic Boogie.

And it seemed to be working. His pressure cam up, he woke up, and the surgeons clustered, waiting. A little voice piped up: "Maybe... just maybe..."

But then he got to theatre, and the surgeons volte face-d.

Now, I'm not a vascular knifeman. Never was, so I'm sure the decision was the right one. Of course it was. And I knew he was never going to do, but we'd worked so hard to buff him, and had seemed to be working, so I thought he'd at least get knife to skin.

Somehow, it just seemed harder to take than if he'd never perked up at all.

Still; we tried, and maybe this means I do still have a soul.

Monday, September 21, 2009

Coming Soon...

By popular demand, more on the adventures of LBF, and a new character to grace the soap opera that is Shroom's life.

Moving On...

The written part of my exams have been and gone, and I passed. It feels like an anti-climax, something that ha sbeen weighing heavily on every aspect of my life for almost a year; still, at least, as Colossus put it, I didn't "fuck it up at the first hurdle"

I now have parts 2 and 3 to come, and remian pessimistically sure that I'll fuck oneof them up. Even if I don't, my contract runs out in January, and i really haven't figured out where I want to work next / for the rest of my life yet.

I have also gone full circle, and back to South Coast General, where I started my Specialist Training. The all seem pleased to see me, which makes me wonder what I did right the first time around, and fills me with fear that I can only be a crushing disappointment this time around.

South Coast General is busy. I had forgotten quite how busy. South Coast Teaching was busy, and I had thought the two were comparable.

They aren't.

I'm not sure that it's just numbers; I'm sure that ED footprint size makes a difference. SCG is much smaller, and although they have a brand new Hospital bolted on, beds always seem in short supply. Staffing, although better than when I started, is, I suspect, still inadequate.

Whatever the causes, SCG is busy, and the pressure is, as ever, to meet the targets. It makes me uncomfortable; I really feel that all the patients I see are getting about three quarters the work up they should get, in order to feed to time target monster.

This can't be right; I don't believe it's how it should be, and I think it's only going to get worse.

Good From Afar...

I t has been suggested to me that I should be writing more, and indeed, more about certain subjects; I surely agree that to keep my part in our covenant, dear reader, I should be writing more. Writing under duress, however, worries me; I worry that my output will resemble drivel more than usual. Duress, is probably too strong a word, and I certainly need the prodding.

Well I'll try.

I had something I wanted to pitch about close ups. Real and figurative. La Belle Fille shouldtake particular note that this an example of me thinking out loud in general terms, and not talking about specifics.

I had ben struck by how many things in modern life look very shiny, or nice, or fun, until you see them close up, until you see their faults writ large. Everything, everybody has faults, but I fear modern life conditions us to expect the impossible, that everyting should be blemish-free.

Maybe I'm just disappointed in myself for buying into it.

Once again, this is just aimless generality. I think its important that we should all be aware of that.