As you know, I'm not one to grumble...
I have just found myself in the delightfully uncomfortable position of being underpaid by my current trust, while having been overpaid by my previous trust.
Brilliant
Friday, February 19, 2010
Thursday, February 18, 2010
Black Ops
Mystery wrapped in enigma.
One of my esteemed colleagues was working when a blue call came in. Young male, cardiac arrest, immersion. Failed resuscitation.
The exact mechanism was... well, unclear. He's been in the water, but not for long, and there were no details about the patient.
He was accompanied by some heavyset, serious looking gentlemen, who were evasive about who they were and whether they knew the deceased.
They wanted to claim the body though, but something didn't quite ring true.
A young man, in the service of his country, perhaps? Lost his life, somehow. On a foreign field?
We never did find out, and can't imagine we ever shall.
One of my esteemed colleagues was working when a blue call came in. Young male, cardiac arrest, immersion. Failed resuscitation.
The exact mechanism was... well, unclear. He's been in the water, but not for long, and there were no details about the patient.
He was accompanied by some heavyset, serious looking gentlemen, who were evasive about who they were and whether they knew the deceased.
They wanted to claim the body though, but something didn't quite ring true.
A young man, in the service of his country, perhaps? Lost his life, somehow. On a foreign field?
We never did find out, and can't imagine we ever shall.
Wednesday, February 17, 2010
Space Oddity
Another cluster of odd presentations; I can't quite figure these guys out either.
Invariably young males, usually adolescent, all complaining of lower abdominal pain, and an inability to urinate. All claim not to have pee'd for at least 24 hours. None have a distended bl;adder, nor any obvious cause for retention, nor any renal impairment, as measured biochemically.
Few, if any, have signs of infection, although I suppose an STI must be high on the list.
What I can't quite figure is that tey MUST have been urinating, and yet swear blind that they haven't.
One of us must be wrong...
It can't be me, can it?
Invariably young males, usually adolescent, all complaining of lower abdominal pain, and an inability to urinate. All claim not to have pee'd for at least 24 hours. None have a distended bl;adder, nor any obvious cause for retention, nor any renal impairment, as measured biochemically.
Few, if any, have signs of infection, although I suppose an STI must be high on the list.
What I can't quite figure is that tey MUST have been urinating, and yet swear blind that they haven't.
One of us must be wrong...
It can't be me, can it?
Tuesday, February 16, 2010
No Help Required
While out and about on the Streets of LBFville, we were hailed by a couple of teens, supporting a third, semi-conscious, mate. They wanted help getting him up, so they could get him home. This is, in itself, admirable.
The mood was spoiled somewhat when they stopped worrying about him, and started begging for ciggies when we went over.
Info was fairly sparse, but it was apparent he had drunk ' a lot', and was sparko. Try as I might, I couldn't raise a peep out of him. Getting him home seemed increasingly ambitious.
As always in situations like this, a crowd gathered.They were all drunk too, and not really a great help.
By this time, I was making some progress at the head end, and he was beginning to respond to my less than gentle ministrations.
Suddenly home didn't seem such a far off dream after all.
I tried to engage his friends in this idea, but, the crowd told me, an ambulance had been called.
"Don't worry", they said, pointing to one of their number, "he's a first year medical student, at Oxford"
I opened my mouth, then closed it again. The 'casualty' was breathing well, and beginning to stir; an ambulance was en-route, and I had been trumped.
I left them to it.
The mood was spoiled somewhat when they stopped worrying about him, and started begging for ciggies when we went over.
Info was fairly sparse, but it was apparent he had drunk ' a lot', and was sparko. Try as I might, I couldn't raise a peep out of him. Getting him home seemed increasingly ambitious.
As always in situations like this, a crowd gathered.They were all drunk too, and not really a great help.
By this time, I was making some progress at the head end, and he was beginning to respond to my less than gentle ministrations.
Suddenly home didn't seem such a far off dream after all.
I tried to engage his friends in this idea, but, the crowd told me, an ambulance had been called.
"Don't worry", they said, pointing to one of their number, "he's a first year medical student, at Oxford"
I opened my mouth, then closed it again. The 'casualty' was breathing well, and beginning to stir; an ambulance was en-route, and I had been trumped.
I left them to it.
Monday, February 15, 2010
Valentino
Another Valentine's passed.
The cynic in me says this is really just a great money spinner for jewellers / gift manufacturers / card makers etc, but it is undenisably nice to remind someone how much they mean to you.
I had planned a little break for LBF and I, but things don't always break the way you want to. Firstly I couldn't get the time off work, or at least not without really making some enemies, which is never a good idea. Then I contrived not to see the folks for a while, and Pa Shroom's birthday falls right after Hallmark card day, so I kindof had to hook up with them...
Anyway, I managed to spend some time with LBF and not fuck up the presents I bought for her. We also saw the film Valentine's Day which was... interesting.
It may not have been the most romantic of weekends, but I think it was a good one.
The cynic in me says this is really just a great money spinner for jewellers / gift manufacturers / card makers etc, but it is undenisably nice to remind someone how much they mean to you.
I had planned a little break for LBF and I, but things don't always break the way you want to. Firstly I couldn't get the time off work, or at least not without really making some enemies, which is never a good idea. Then I contrived not to see the folks for a while, and Pa Shroom's birthday falls right after Hallmark card day, so I kindof had to hook up with them...
Anyway, I managed to spend some time with LBF and not fuck up the presents I bought for her. We also saw the film Valentine's Day which was... interesting.
It may not have been the most romantic of weekends, but I think it was a good one.
Sunday, February 14, 2010
...Just A'Feelin' 'Bout Half Past Ten
Listening to the radio a while back, I was impressed by the blase attitude of some Australian OAPs I heard on the radio.
They were describing their experiences of recent bushfires. and were embarrassingly matter-of-fact about it, and how they coped.
I wonder if this is a product of the knowledge of a life well lived?
I'm not sure, but I can only dream of such aplomb and self possession.
They were describing their experiences of recent bushfires. and were embarrassingly matter-of-fact about it, and how they coped.
I wonder if this is a product of the knowledge of a life well lived?
I'm not sure, but I can only dream of such aplomb and self possession.
Saturday, February 13, 2010
Rode Into Nazereth...
I have had to admit, or at least refer for admission, a number of patients recently in a genuine display of Cover Your Ass medicine. I hate practicing CYA medicine, and yet it seems to form an increasing part of my practice. Evidence Based Ass Covering.
Increasing seniority brings with it a diminishing ability to be wrong. Mistakes are allowed, almost expected of junior staff, and as long as they aren't disastrous... well, you know what I mean.
However, the ever increasing pressure of the 4 Hour target (All Hail) gives me less and less time to think about what's wrong with, and what's best for my patients.
And so, I end up referring those folks who just aren't right. I am losing faith in my clinical acumen, because I know I can't always be right, and I can't afford to be wrong.
Of late I have seen a number of folks who present with odd neurology - non-anatomical numbness, or transient, fleeting symptoms, or symptoms that just don't match the signs.
And they are almost invariably drunk. And will deny this.
I am sure they have no pathology, but I can't send someone home who is telling me the whole right side of their body is numb. Can I?
Increasing seniority brings with it a diminishing ability to be wrong. Mistakes are allowed, almost expected of junior staff, and as long as they aren't disastrous... well, you know what I mean.
However, the ever increasing pressure of the 4 Hour target (All Hail) gives me less and less time to think about what's wrong with, and what's best for my patients.
And so, I end up referring those folks who just aren't right. I am losing faith in my clinical acumen, because I know I can't always be right, and I can't afford to be wrong.
Of late I have seen a number of folks who present with odd neurology - non-anatomical numbness, or transient, fleeting symptoms, or symptoms that just don't match the signs.
And they are almost invariably drunk. And will deny this.
I am sure they have no pathology, but I can't send someone home who is telling me the whole right side of their body is numb. Can I?
Friday, February 12, 2010
It's Not The Falling That Hurts...
It's the landing.
Obviously.
Apologies, dear readers, all 40 or so of you. I have fallen off the wagon of late, slipped the traices. Got lazy. Been betrayed by technology.
Got behind.
My continued mission to moan about feeling unwell culminated in me failing at all my tasks this month. I have run very little, if at all; I have succumbed to the evil tobacco weed, and I have gotten behind with this monstrosity.
In my defence, I have been feeling increasingly unwell, a fact I am blaming on my anti-retroviral meds, which seem to produce a constant background of feeling shit; a sort of physiological equivalent of drizzle; I had lined some posts up for delayed publication, but that seems to have failed.
But it's time to get back up again.
Back up, stub out the butt, jog on and then write about it.
Good luck everyone.
Obviously.
Apologies, dear readers, all 40 or so of you. I have fallen off the wagon of late, slipped the traices. Got lazy. Been betrayed by technology.
Got behind.
My continued mission to moan about feeling unwell culminated in me failing at all my tasks this month. I have run very little, if at all; I have succumbed to the evil tobacco weed, and I have gotten behind with this monstrosity.
In my defence, I have been feeling increasingly unwell, a fact I am blaming on my anti-retroviral meds, which seem to produce a constant background of feeling shit; a sort of physiological equivalent of drizzle; I had lined some posts up for delayed publication, but that seems to have failed.
But it's time to get back up again.
Back up, stub out the butt, jog on and then write about it.
Good luck everyone.
Thursday, February 11, 2010
Choice
I support choice. It is a good thing.
Mostly.
Sometimes, I think people abuse it.
Tonight, I saw 2 people whose choices upset me.
Which is a shame; the thing about choice, individual choice, is that it should be just that. Individual, not affecting anyone else.
But, of course, that is pretty much an abstract concept. Every choice we make is bound to have knock on consequences for others.
Maybe it's the reasons behind the choices that needle me? Maybe I have no right to be bothered by them.
The first choice I didn't really understand, nor the motivation behind it. Maybe that's the point. A young man, seeing his Cardiologist privately, has a dysrhythmia. His heart, intermittently, short circuits, surrendering the regular, ordered beat that thrums out our lives, for a cacophonous, disordered, irregular beat.
A number of treatment options are unfolded for him, and many rejected, some because they are unpalatable, or do not work. One is agreed upon; it seems simple enough, and yet he chooses not to bother.
And so to the ED. Why bother asking for, and taking, an opinion if you won't follow up on it?
Too busy? Forgot? Didn't seem important enough?
Maybe I just don't like this choice because the end result has been another patient in the ED, and maybe I'm workshy. But maybe I know choosing not to treat conditions sometimes has consequences.
The second patient was visiting their alternative health provider when they collapsed. Deep coma followed, and CT showed the deadly tendrils of sub-arachnoid blood, snaking around, and over the brain. The patient, it turns out knew they had high blood pressure, but elected to take herbal remedies rather than prescription meds. Because they didn't want to end up taking a pill for life. Was this choice made in the knowledge that there is little difference in taking a herbal remedy for life, versus taking a prescribed drug for life, purely in terms of the taking?
Is it any comfort that life had turned out to be much shorter this way? Did they make the choice knowing what the consequences would be, or at least could be?
I doubt it, and am ashamed to say I had to bite my tongue to stop from telling her family what a ridiculous choice this seemed to be to me. Not my choice to make, not my place to offer an opinion after the fact.
As if they needed any more evidence.
Mostly.
Sometimes, I think people abuse it.
Tonight, I saw 2 people whose choices upset me.
Which is a shame; the thing about choice, individual choice, is that it should be just that. Individual, not affecting anyone else.
But, of course, that is pretty much an abstract concept. Every choice we make is bound to have knock on consequences for others.
Maybe it's the reasons behind the choices that needle me? Maybe I have no right to be bothered by them.
The first choice I didn't really understand, nor the motivation behind it. Maybe that's the point. A young man, seeing his Cardiologist privately, has a dysrhythmia. His heart, intermittently, short circuits, surrendering the regular, ordered beat that thrums out our lives, for a cacophonous, disordered, irregular beat.
A number of treatment options are unfolded for him, and many rejected, some because they are unpalatable, or do not work. One is agreed upon; it seems simple enough, and yet he chooses not to bother.
And so to the ED. Why bother asking for, and taking, an opinion if you won't follow up on it?
Too busy? Forgot? Didn't seem important enough?
Maybe I just don't like this choice because the end result has been another patient in the ED, and maybe I'm workshy. But maybe I know choosing not to treat conditions sometimes has consequences.
The second patient was visiting their alternative health provider when they collapsed. Deep coma followed, and CT showed the deadly tendrils of sub-arachnoid blood, snaking around, and over the brain. The patient, it turns out knew they had high blood pressure, but elected to take herbal remedies rather than prescription meds. Because they didn't want to end up taking a pill for life. Was this choice made in the knowledge that there is little difference in taking a herbal remedy for life, versus taking a prescribed drug for life, purely in terms of the taking?
Is it any comfort that life had turned out to be much shorter this way? Did they make the choice knowing what the consequences would be, or at least could be?
I doubt it, and am ashamed to say I had to bite my tongue to stop from telling her family what a ridiculous choice this seemed to be to me. Not my choice to make, not my place to offer an opinion after the fact.
As if they needed any more evidence.
Wednesday, February 10, 2010
And Death Followed After
More evidence, if any such was required, that I attract trouble, that I am a 'Black Smoke' Registrar.
'Twas darkest night, tho the moon shone bright (which may be oxymoronic), when the clock struck shit.
That's right. I said the clock struck 'shit'. I would like to propose the term 'shit o'clock' to represent the time in the Department when the shit hits the fan. I suppose 'arse o'clock' would be acceptable, or indeed 'trouble o'clock', if you are less foul mouthed.
Anyway, all had gone just fine, until shit o'clock.
The BatPhone rang trilling of the impending arrival of a young sailor who had fallen 20 feet from a gate, part of which had detached itself and landed on his leg. He had, somewhat amazingly, avoided other injury, but as we peeled back the splinting on his lower leg, it became apparent that that was more than enough.
It was shattered, ivory white splinters of bone prodding obscenely through what was, under the circumstances, a relatively neat wound. It really was smashed.
It was then that the BatPhone belched into life again, this time announcing the arrival of a woman stabbed in the neck, and shocked.
While still digesting this, the Phone sounded again, this time forewarning of a patient in drink, having sustained a head injury, and with a GCS of 3. The paramedic calling chose an unfortunate turn of phrase to indicate that the patient was in Police custody.
"In drink, head injury with GCS 3; oh, and he's arrested."
So I was significantly relieved to see him full of pulse and breathing when he rolled in, seconds after the stabbing.
I barely noticed the arrival of the second stabbing victim
'Twas darkest night, tho the moon shone bright (which may be oxymoronic), when the clock struck shit.
That's right. I said the clock struck 'shit'. I would like to propose the term 'shit o'clock' to represent the time in the Department when the shit hits the fan. I suppose 'arse o'clock' would be acceptable, or indeed 'trouble o'clock', if you are less foul mouthed.
Anyway, all had gone just fine, until shit o'clock.
The BatPhone rang trilling of the impending arrival of a young sailor who had fallen 20 feet from a gate, part of which had detached itself and landed on his leg. He had, somewhat amazingly, avoided other injury, but as we peeled back the splinting on his lower leg, it became apparent that that was more than enough.
It was shattered, ivory white splinters of bone prodding obscenely through what was, under the circumstances, a relatively neat wound. It really was smashed.
It was then that the BatPhone belched into life again, this time announcing the arrival of a woman stabbed in the neck, and shocked.
While still digesting this, the Phone sounded again, this time forewarning of a patient in drink, having sustained a head injury, and with a GCS of 3. The paramedic calling chose an unfortunate turn of phrase to indicate that the patient was in Police custody.
"In drink, head injury with GCS 3; oh, and he's arrested."
So I was significantly relieved to see him full of pulse and breathing when he rolled in, seconds after the stabbing.
I barely noticed the arrival of the second stabbing victim
Tuesday, February 09, 2010
Pay Attention
I have seen a few tricks deployed to 'jump the queue' in the ED. Last night's took the biscotti. A patient old enough to know better presented heavily inebriated, having turned their ankle. Quick exam off the Ambulance trolley suggested a bad sprain, but probably a fracture. There was swelling, for sure, but no neurovascular embarrassment, and he beer jacket was providing adequate analgesia.
The Department was kicking, heaving, alive with criticals, and sicker people needing trolleys. She would have to wait, and we apologised for this, and left her in a chair.
She muled this over for a while, and took maters into her own hand. She levered herself out of the chair, took a step, tottered for a second, and before we could reach her, turned her ankle again.
Through 90 degrees.
What had seemed a simple injury suddenly became very complex, and her foot turned white. Our efforts to restore anatomy and circulation were hampered by the patient's state of mind.
I'm not sure where she thought she was, but was incapable of grasping the (relatively) simple concept that she was in hospital, and had a (now) badly dislocated ankle.
She fought us every step of the way, and we had to settle for a half baked job, afraid as we were of over sedating her and adding aspiration to her growing list of injuries. We managed to go from dislocated to subluxed, from white and cold to purple and warm, pulses restored if anatomy stubbornly remaining abnormal.
She at leas got seen quickly, even if she never walks quite the same way again.
The Department was kicking, heaving, alive with criticals, and sicker people needing trolleys. She would have to wait, and we apologised for this, and left her in a chair.
She muled this over for a while, and took maters into her own hand. She levered herself out of the chair, took a step, tottered for a second, and before we could reach her, turned her ankle again.
Through 90 degrees.
What had seemed a simple injury suddenly became very complex, and her foot turned white. Our efforts to restore anatomy and circulation were hampered by the patient's state of mind.
I'm not sure where she thought she was, but was incapable of grasping the (relatively) simple concept that she was in hospital, and had a (now) badly dislocated ankle.
She fought us every step of the way, and we had to settle for a half baked job, afraid as we were of over sedating her and adding aspiration to her growing list of injuries. We managed to go from dislocated to subluxed, from white and cold to purple and warm, pulses restored if anatomy stubbornly remaining abnormal.
She at leas got seen quickly, even if she never walks quite the same way again.
Monday, February 08, 2010
Sunday, February 07, 2010
Saturday, February 06, 2010
Friday, February 05, 2010
Cold As A New Razor Blade
I demonstrated, somewhat to my embarrassment, this morning, that after a long night, I am prone to display my primate heritage.
Absent mindedly writing my notes at the desk, I was shakne from my reverie by a coughing from across the desk.
I glanced up. 'Yes?', I enquired.
My SHO trying not to meet my gaze. 'You're... ummmm...'; 'Yes?', quoth I; 'You're... scratching yourself'.
I glanced down.
My hand, unbidden had answered the call of the wild, and I had disgraced myself on Majors, all too in touch with my inner chimp.
Absent mindedly writing my notes at the desk, I was shakne from my reverie by a coughing from across the desk.
I glanced up. 'Yes?', I enquired.
My SHO trying not to meet my gaze. 'You're... ummmm...'; 'Yes?', quoth I; 'You're... scratching yourself'.
I glanced down.
My hand, unbidden had answered the call of the wild, and I had disgraced myself on Majors, all too in touch with my inner chimp.
Thursday, February 04, 2010
iFlail
La Belle Fille has made the jump to the iPhone. (Other phones are available) As with all new tech, there were a few teething problems.
So, shortly after she signed up for it, and whipped it out of it's box, I received a phone call. This one consisted of a few plaintive "hello"s by both parties, and her hanging up. Another call followed, which she hung up as soon as I answered. Then another, which consisted of LBF simply uttering the word: 'bollocks'.
After a few more abortive efforts, it became apparent that she was struggling with the volume controls.
A text followed, asking me to call her, to check that her phone was working. This call passed off without incident, barring much laughter in the background at her end.
The cause: having taken the phone back, and proclaimed it defunct, the phone guy had taken it from her, examined it and then removed the plastic 'screen protector' see-thru label that had been neatly, invisibly obscuring the earpiece of her new, shiny piece of tech.
So, shortly after she signed up for it, and whipped it out of it's box, I received a phone call. This one consisted of a few plaintive "hello"s by both parties, and her hanging up. Another call followed, which she hung up as soon as I answered. Then another, which consisted of LBF simply uttering the word: 'bollocks'.
After a few more abortive efforts, it became apparent that she was struggling with the volume controls.
A text followed, asking me to call her, to check that her phone was working. This call passed off without incident, barring much laughter in the background at her end.
The cause: having taken the phone back, and proclaimed it defunct, the phone guy had taken it from her, examined it and then removed the plastic 'screen protector' see-thru label that had been neatly, invisibly obscuring the earpiece of her new, shiny piece of tech.
Wednesday, February 03, 2010
Simple Joys Unbounded
I can't remember if I've blogged about this before.
If I have, please accept my apologies, and blame the dementia.
A little before Christmas, I spotted an unusual combination. A man in his late middle years, looking utterly fed up, carrying way too much weight, out walking a dog. I wasn't sure it was his, as the two seemed very badly matched.
The dog looked to be a terrier puppy, and had the look of joy unbounded I am prone to attribute to dogs when anthropomorphising them. But he did look to be grinning. He was also full of puppy based energy, and ran everywhere, in a slightly ungainly puppy run - both forelegs, then both hind legs. The man seemed unable to keep up, and simply settled for stopping in the middle of a grassy knoll, and letting the puppy run madly, round and around on the end of an extendable lead.
I saw them again a few days later, the same delightful juxtaposition of their affects apparent.
Best of all, a little later still, I saw them again, simply walking this time, except that the puppy had had a jacket made for it, resplendent in Christmas lights.
If you've never seen a puppy gallivanting the streets clad in a twinkling dog jacket, you haven't known true happiness.
'Nuff said.
If I have, please accept my apologies, and blame the dementia.
A little before Christmas, I spotted an unusual combination. A man in his late middle years, looking utterly fed up, carrying way too much weight, out walking a dog. I wasn't sure it was his, as the two seemed very badly matched.
The dog looked to be a terrier puppy, and had the look of joy unbounded I am prone to attribute to dogs when anthropomorphising them. But he did look to be grinning. He was also full of puppy based energy, and ran everywhere, in a slightly ungainly puppy run - both forelegs, then both hind legs. The man seemed unable to keep up, and simply settled for stopping in the middle of a grassy knoll, and letting the puppy run madly, round and around on the end of an extendable lead.
I saw them again a few days later, the same delightful juxtaposition of their affects apparent.
Best of all, a little later still, I saw them again, simply walking this time, except that the puppy had had a jacket made for it, resplendent in Christmas lights.
If you've never seen a puppy gallivanting the streets clad in a twinkling dog jacket, you haven't known true happiness.
'Nuff said.
Tuesday, February 02, 2010
Dr Shroom's All-Stars
Final line up:
Vocals: Janis Joplin and Freddy Mercury
Guitars: Eric Clapton and Jimi Hendrix
Bass: John Paul Jones
Drums: Keith Moon
Keyboards: Steve Winwood
Piano: Billy Preston
Brass: The Miami Horns
Sax: King Curtis
Probably...
Vocals: Janis Joplin and Freddy Mercury
Guitars: Eric Clapton and Jimi Hendrix
Bass: John Paul Jones
Drums: Keith Moon
Keyboards: Steve Winwood
Piano: Billy Preston
Brass: The Miami Horns
Sax: King Curtis
Probably...
Monday, February 01, 2010
Medic!
I recently finished a book about the role of the Military Medic. It was well enough written, if a little partisan at times. It was called, aptly enough, 'Medic' and is by John Nicol, Tony Rennell and Eleo Gordon. I would commend it to you.
One of the soldiers detailed in its pages lost his life in the service of his country, and his daughter sang at the 25th Anniversary Memorial service. The song she chose was originally by Steeleye Span, great purveyors of folky-dolky, if you're that way inclined.
Anyway, I uncovered her performance on YouTube, that grand old repository of... well, everything really.
So, a propos of nothing, I include it here. I suggested to La Belle Fille she include it in her singling repertoire, but she suggested it might prove too sad. Or maybe she just didn't like it.
Anyway, I'm not particularly pro-war, but I am pro-soldier, and especially the combat medics, many of whom I trained with, and all of whom have great big brass ones, as far as I'm concerned.
And it's a damn fine song.
One of the soldiers detailed in its pages lost his life in the service of his country, and his daughter sang at the 25th Anniversary Memorial service. The song she chose was originally by Steeleye Span, great purveyors of folky-dolky, if you're that way inclined.
Anyway, I uncovered her performance on YouTube, that grand old repository of... well, everything really.
So, a propos of nothing, I include it here. I suggested to La Belle Fille she include it in her singling repertoire, but she suggested it might prove too sad. Or maybe she just didn't like it.
Anyway, I'm not particularly pro-war, but I am pro-soldier, and especially the combat medics, many of whom I trained with, and all of whom have great big brass ones, as far as I'm concerned.
And it's a damn fine song.
Subscribe to:
Posts (Atom)