eclipseArts Circus: Welcome to the first eclipseArts blog entry.

eclipseArts Circus: Welcome to the first eclipseArts blog entry.: Although eclipseArts have been in the biz for fifteen years, it’s never occurred to us to write a blog before. I mean, computers, what...

19th Nervous Breakdown

I'm afraid it has all caught up with me. Maybe you do have to hit rock bottom. I think I may have done just that.

Whether I can climb back up again...

Time will tell.

For now, I have been fired in the crucible, and found wanting.

I'm sorry.

I hope it doesn't end this way...

30 Day Song Challenge 30

30: Your Favourite Song This Time Last Year.

Damned if I can remember.

It might have been this.

Seriously. Who remembers stuff like this?

Really Bored

But this was just too much fun to ignore; I've got a lot of time for this guy - Mighty Mike. Check his site, it's (now) in my blogroll...

Yes, I'm Bored

But is that Marc Bolan, Ronnie Wood and Elton all in the same video? Plus, I reallly love Bowie. And his son's films aren't too shabby, either...

Random Finds

I might have posted this before; I dunno.

I can't believe they didn't win...

30 DSC Day 29

29: A Song From Your Childhood

Define childhood. As a wee nipper, it might have been more Neil Diamond. So; two selections, one inherited from Ma and Pa, and one from my tween years.

Encore Une Fois

Best I can come up with, but a video that speaks redemption, and isn't Redemption Song. Listened to this far too much when revising for my membership (the third time, when I finally passed... so maybe no bad thing)

Further Interlude

Still can't think of a song that makes me feel guilty; I'm sure there must have been songs playing when I've been up to no good, doing things that I should be ashamed of, that should make me feel guilty.

I appear to have successfully blotted them out of my mind.

I feel guilty about a variety of things; it comes with the territory of a Catholic upbringing, and I suspect this is not the forum for me to go over them. It would make terribly dull reading.

I might as well tell you how much my back hurts today.

(More than usual)

I am struggling to shake the memory of the epistaxis patient who arrested on my watch. Could I have done more? Could anyone?

We'll never know. There's no reset button, no save point to return to. I've looked.

You just have to plough on, apparently.

I really need a break.

Or some therapy.

30 DSC Day 28

28: A Song That Makes You Feel Guilty.

Nope.

Nothing springs to mind.

I'll think on it. (I'm scribing this two weeks in advance)

30 DSC Day 27

27: A Song You Wish You Could Play

Applies to almost all the songs thusfar listed. In fact, I like to be able to play any song.

As the old gag goes, I'd give my right arm to be able to play guitar like this.

30 DSC Day 26

26: A Song That You Can Play On An Instrument.

Cupboard is bare again, I'm afraid. Can't play, for toffee.

30 DSC Day 25

25: A Song That Makes You Laugh.

Scant pickings. I'll offer two; one a 'proper' song, the other intentionally comedic.

The Big Chill

In case you were wondering...

30 DSC Day 24

24: A Song You Want Played At Your Funeral

Another one that gave me cause to think. Quite fancied the organ version of Can't Always Get What You Want from The Big Chill.

If you're confused, go find the film, and watch it; you won't be disappointed, and you can play 'Spot Kevin Costner' while you're at it.

Anyway. I chose this.

(There is another live version on YouTube, but I wasn't keen on the sound quality, and this one coincides with the intro to one of my favourite films...)

30 DSC Day 23

23: A Song You Want Played At Your Wedding.

Well... another long list, but this my favourite, right now. (And that doesn't break my no duplicates rule)

Not sure I'd get away with it...

Imagine my surprise when I found this version...

30 DSC Day 22

22: A Song You Listen To When You're Sad.

Too many to count, but this is an oldy, one I used to over-lsten to mourning the break-up of a relationship.

I can still smell her perfume when I hear this song. I think (hope) she's happy now. Most of my exes seem to be. Maybe I'm a pit stop on the road to happiness.

Yes, I know, I'm wallowing

30 DSC Day 21

21: A Song You Listen To When Happy.

Add your own punchline.

Happy or sad, this song always cheers me up; another great talent gone too soon.

Shaking What You've Got

Another interlude. Typing on my iPhone, so may be shorter than usual. It's awkward, and the events herein upset me.

On how things go wrong, and on not knowing.

The patient, hypothetical as always, might have been middle aged and in renal failure requiring regular dialysis. Imagine they present with a nosebleed. These are the patients who carry a burden of hindsight with them. It is neatly packaged, and in my experience you won't see it unless you're careful.

Patients with open fractures, overdoses, an overcrowded Paeds Department: all of these things might get in your way, might cloud your vision.

Suppose the bleeding starts again. It's obviously vigourous; despite packing, blood continues to flow freely, from the other nostril and from the mouth, obviously coursing down the back of the nasopharynx. Threatening to choke her, but not quite making good on this threat.

Imagine you can't see anything to cauterise; more packs? A foley to tamponade posterior bleeding? Something I've not done much of. Will it make it worse?

Patient is stable; call ENT. You will tell yourself it makes the most sense; you have other patients, this one is ok (now) and needs an expert.

Half an hour later, you're bagging the patient; the airway resembles an abattoir. The tube goes in ok, and maybe 10 minutes of CPR will get him back.

But your patient came with a nosebleed, and arrested while you watched.

Could I have done more? Should I have?

I feel like I'm burning out

These patients, hypothetical as they are, are the ones that will challenge your very soul.

If you still have one.

30 DSC Day 20

20: A Song You Listen To When You're Angry

Well; no Fooling. I don't really have any of these. Plenty of songs I listen to when I'm Sad; but no angry playlist. I ummed and aahed about choosing something by Rage Against The Machine, or Metallica (One, probably). Or Nirvana?

But settled on this, instead.

It's an angry song, at least.

Sung by another (dead) guy I have a little man-crush on.

30 DSC Day 19

19: A Song From Your Favourite Album

I have had to fudge a bit here. Van Morrison's Astral Weeks is probably my favourite, or Let It Bleed, or Get Yer Ya-Ya's Out by The Stones.

They've both featured, so I'll default to my next favourite album: Let It Be

There are innumerable videos for this song out there, including a demo where Paul swears at the beginning that I found once, but never again, and one where some dude has overdubbed the two different guitar solos; but I like this version; under-produced, nice backing "ooo-ooo"s.... though if I'm honest I prefer the original (album) solo. It's... dirtier.

Go, seek, find

Edit: Persistance does pay, it would seem, although my memory isn't what it was apparently. A demo with heavy vocals, bass and swearing, at about 1:54.

So not the beginning; and not Paul either, I think. I'm pretty certain this is the 'rude' version I remember, since that's what I remember him saying.

Anyway. One for the geeks.

30 DSC Day 18

A Song You Wish You Heard On The Radio

Another topic for which I could provide a dozen or so songs...

I'm trying not to duplicate artists, or songs, as there are a number of tunes that would answer any number of these 'subjects'.

Anyway, anything by this man would be welcome.

Interlude: Referral Politics 2

So: the last of the epic tales of my on call.

I knew I'd be late on the floor; 2 down and busy, no way was I getting off on time. Half two in the morning is close to my limit. If there are sick patients, well, strap on when it seems apt, but if its just busy...

As I was preparing to escape, I was introduced o one of my absolute favourite ED dilemmas. The 'problem' patient that no-one will admit, or discharge. Typically, this will be someone well known to one service, or more than one, with a chronic problem. They inevitably attend out of hours, with a flare of their problem, usually requiring strong painkillers.

In this case, the problem was abdominal pain. Surgical review diagnosed "not a surgical problem' with a plan of "refer medics'. But of course, the surgeon couldn't possible make that referral. Since the problem is "not surgical", the patient reverts to us.

Medical review resulted in a diagnosis of "not a medical problem", with a proposed plan of "have the surgeons admit, and we'll review"

This backing and forthing can go on for days.

It is a waste of everyone's time, especially my registrar's.

Usually, a polite call is enough. It makes sense for the two specialities to talk to each other, and agree a mutually acceptable plan, or discharge the patient.

Being a consultant, it has the added advantage that I can always suggest if they don't want to talk, I'll call their bosses in, and we three consultants can review the patient at the bedside, and agree a plan. After all, I'm still here at 3 a.m., I'm sure their bosses wouldn't mind coming in to join me?

Well, I left them talking, which doesn't guarantee resolution, of course.

But I'm hopeful.

There may be some follow up here.

Don't touch that dial.

30 DSC Day 17

A Song You Hear Often On The Radio

Problematic, as I mostly listen to Radio 4 and Radio 7, which are all about the talking. When I do listen to music radio, it's usually Chris Moyles on Radio One, which isn't so much about the music...

So it's another blank, I'm afriad

30 DSC Day 16

A song you Used to Love, But Now Hate
Not sure I really hate this on. Not sure there are any songs that I once loved but now hate... But this has been overplayed, so I can't listen to it right now, and that may have to do.

Interlude: Referral Politics

Ah, the joy of the referral.

Times have changed. The all powerful target means less time for us, in the ED to reach a diagnosis; often the decision to refer for admission is based on a lack of a diagnosis, coupled with the fact that the hospital says I can't stop and think.

And so, the soft referral. I like to think that most of my referrals are kosher, and if I'm not sure, I'm honest about it. But sometimes, I just don't know what's wrong with a patient, but I'm pretty certain they need longer obs than I can offer in the ED, and maybe more tests. (More tests! The answer to everything!)

I had just a conundrum recently, and was given a hard time by the MedReg. Not necessarily inappropriately; I really couldn't figure out what was afoot, but I tried to be honest about that, and why I though the patient ought to come in.

Her SHO, one of our old trainees, told me a few days later, that she hadn't realised to whom she was speaking, and had been apologetic thereafter. (Apologetic, or worried that I might complain?)

This, of course, if bullshit. If she was rude, and I didn't think she was, especially, then who i am is irrelevant. No mater what some practitioners seem to think, there isn't a sliding scale of how rude you can be to someone, based on their job title.

If, on the other hand, she thought the referral was shit, who I am is equally irrelevant. Shit referrals transcend all boundaries.

Anyway. Last week, I'd seen a young girl, complaining of pleuritic, left sided chest pain, shortness of breath and cough. No temp, pulse 120 bpm, resps 30. Normal bloods, normal chest XR, normal gases. Despite her normal gas, I was still concerned about PE.

(The arterial blood gas measures oxygenation of the blood, and, in pulmonary embolus, should be abnormal.)

The MedReg was distinctly unimpressed, and wanted to know why I hadn't asked for a d-dimer.This is a blood test that, if positive, may indicate the presence of clot. It's more often used to rule the condition out, as it is more commonly negative when there is NO clot, than it is positive when there IS clot.

However, in certain circumstances, where risk is perceived to be high enough, even a negative d-dimer isn't really enough to rule out PE. This is, broadly, Bayesian probability, which deals with pre test probability, and how the result of a given test influences that figure to generate post test probability.

So for example if you have a 15% chance of having a PE, and negative d-dimer would allow me to reduce that below 1%, and I might say that's enough to rule it out. But if the pre test is higher, maybe 50%, then with a negative d-dimer, your post test is only maybe 5 or 6%. Enough to rule out?

I think not.

We backed and forthed on this for a while. Ultimately, it came down to, if she doesn't have a PE, why is she in pain, tachycardic and tachypnoeic. I CAN"T send her home. If she settles in 12 hours - brilliant. If she goes home and dies...

Not so good.

Now, I'm pretty boring, so I'm happy to talk Bayesian probability theory, and the evidence behind d-dimer all night. But it occurs to me that my juniors probably notsomuch, and this was all a bit hard work, for what may have been a soft referral, but was, at the end of it all, a patient with ongoing symptoms, and abnormal vitals.

I've seen cases like this before; not many. One or two, maybe, but that's all you need to know that sometimes what seems unlikely turns out to be real.

And I'm happy for a few uppity fellows to think me a por diagnostician, in exchange for avoiding the coroner's court.

30 DSC Day 15

15: A Song That Describes You.

Another one I'm prepared to edit.

Describes vs. sums up.

Comments please.

It's a funky song, anyway....

I've added a live version. The live vid has several details in it that I just love. You'll know when you see 'em; the Devil is in the detail.

Interlude: Politics

The first of a few posts about my last on call; in case, and I can't imagine why this might be so, you're becoming bored of my relentless music Nazi-ism.

Anyway; the following events take place over about 15 hours; I thought about jamming them all into one post, but figured that'd be massive, and might cause forced quit in some readers.

But, the muse is upon m, so I'll write it, and chop it, and preload it.

Part the First. On Hospital Politics.

I am terrible at politics. Terrible. If I was a good politician, I'd be a politician. But I quite want to help my fellow man; so I'm a doctor.

Anyway: for those of you not in the business, there's a lot of politics within even small hospital, an mine's a biggie. I'll be honest with you, I don't really give a shit about it; cheesy as it sounds, all I really care about is doing my job, and making sick people feel better.

I suppose the counterpoint to this is that by being a politician, I can do my job better; but I don't really see it that way. The profession needs politicians, for sure, although those we have appointed have sen us reamed by successive Governments, to the extent that I'm not sure we even count as a profession anymore, so emasculated are we.

So a fat of of good that did. I continue to stand on a single issue platform: what's right for my patient is what I'll do, and you can shove everything else right up your arse.

Vocalising this loudly, sees you marginalised, and less able to influence policy, so it's something of a double edged sword, but there you are.

The point of this rant is this: in the ED, our on-call shifts are rostered from 1pm until 10pm, with additional coverage as needed. We disagree with management on the meaning of that last phrase, but suffice to say, I am almost never off the floor at 10.

My last on call was no different; worse, in fact as we were short handed, and when everyone else goes home at 6, things can go runny very quickly. Rapidly, I had 7 patients needing my 4 bedded resus, and long waits throughout the department.

As I was contemplating taking a break, at about 9, one of our managers (whom I strongly suspect accused me of sloping off on a previous on call: another story) approached me, to tell me that the Duty Exec. was trying to call in the On Call Physician.

As far as I know, this never happens. We all work later these days, in the name of the targets, but I don't think physicians expect to be called in. I'm not sure surgeons do, at least not as much as in Pa Shroom's day, but this is opinion only.

Anyway, he was, so I'm told, declining the offer, unless I wanted him in.

I hate being put in this position. My department was busy, sure. But patients were having to wait longer; all the sick patients were being attended to. So I didn't need him, per se. Of course, extra hands are useful, but a Physician, even an acute one, is NOT an ED Doc, whatever you think.

So, I said I didn't NEED him, but if the Hospital 'escalation' plan called for him to be summoned, that was between him and management.

I'm given to believe he came and was grumpy about it. I never saw him: too busy in resus, but I expect there to be fallout. Questions will have to be answered about why I couldn't cope.

Well, shit happens.

No-one died who shouldn't have done.

Part the next: in which I discuss Bayesian probability with the Medical Registrar

30 DSC Day 14

14: A Song No-One Would Expect...

Another toughie, as it requires me to try and see myself through the eyes of others. I figure I could go either way here, and am prepared to edit if the public tells me so.

This piece is heart stopping, and I think at odds with how my musical taste is generally perceived. I think.

You tell me?

How about this one then ?

30 DSC Day 13

13: Guilty Pleasure

Hmmm... there are a few of these.

Try this on for size.

(There's a bit of banter to get through, but he's talking to Johnny Cash FFS)

(Cut to 2:15, if you have to...)

30 DSC Day 12

12: Song From A Band You Hate.

I'm not linking to anything; pick something by Britney Spears or any boy/girlband of the last 20 years.

30 DSC Day 11

11: Song From Your Fave Band.

Another toughie. Right now, that's probably the Stones, and I'm choosing this song, not only because it's brilliant, but this version shows Mick Taylor at his finest. This slide solo may be my favourite solo of all time, and the video, if you can be bothered shows Mick, beautiful, beautiful Mick, going all Najinsky.

I think I need to stop using the word 'Beautiful'.

30 DSC Day 10

10: A Song That Makes You Fall Asleep.

Don't really have any of those.

I could fall asleep to this one though. Achingly beautiful.

30 DSC Day 9

9: A Song You Can Dance To.

Well... I can't dance, not even for toffee, but I would HAVE to dance to this. Some of you will know why.

30 DSC Day 8

8: A Song You Know All The Words To.

A few of these.

This is probably my favourite.

A slightly 'odd' version, mayhaps?

30 DSC Day 7

7: Song That Reminds You Of A Certain Event

Not an happy event, but there you go. Tried hard to find a video that wasn't Harry Potter orientated; altho' the film introduced me to this song, it is not the event it commemorates.

Honest.

30 DSC Day 6

6: Song That Reminds You Of Somewhere.

Another relatively easy one. I love this song, and will never forget where I was when I first heard it. FWIW, it also reminds me of a person and an event...still

I might add, I was listening to it, so the big man's entrance took me completely by surprise...

30 DSC Day 5

5: Song That Reminds You Of Someone.

This was easy, sort of.

30 DSC Day 4

4: Song That Makes You Sad.

Too many of these to mention.

I choose...

Interlude, Part The Second

Another bad day. Bad for me, worse for others.

I had an unusual case yesterday, wherein a 21 year old lad presented with severe lower limb muscle spasm, and turned out to have bilateral fractured femoral necks; without significant trauma.

Yes, I'm stumped, too.

Today...

the first was a young man, in his 60s, previously well, in cardiac arrest. He had had a colonoscopy the previous day, and returned home without complication; after a few hours at home, he developed severe lower abdominal pain, cramping and colicky, although the notes document that this passed when he opened his bowels and passed flatus.

The notes document that he was symptom free when seen in the ED. He examined normally, and was discharged. Then she couldn't wake him this morning.

By the time he got to us, the Ambos had been working hard for an hour. They couldn't intubate, and I could see why. His jaw was clamped shut, clamped so hard, he'd bitten through his tongue. I couldn't get it to budge a millimetre. Looking down from the head end, I could see my colleagues struggling to straighten his legs out.

No dice.

There's usually only one reason why someone in cardiac arrest has muscle rigidity: rigor mortis. The poor soul had been down for several hours before even the Ambos were on scene, I'd say. We tried, and we tried, but he remained stubbornly in asystole, and his blood gases were those of a dead man.

His wife was utterly unprepared; she pleaded with me to do something, oblivious to my gentle suggestion that he had, in fact, died in the night, and that at best, with a downtime of 90 minutes, even if I could convince his heart to beat, his brain would never recover.

But I couldn't convince his heart to beat.

I knew the accusation would come; she couldn't help it: "He was here last night! Why didn't you see it?"

I had no answer, could barely look her in the eye.

...the second, another young man, found in a collapsed state. Known to be a fitter, prone to slow recovery, he looked post-ictal, but was too slow to come round. He gradually developed some focal signs, his right side becoming tense, spastic and useless, his conscious level ebbing away.

The diagnosis of a prolonged post-ictal phase began to ebb away. CT confirmed what we had all thought: a sizeable intra-cranial haemorrhage. Neurosurgery wasted no time in pronouncing no hope for meaningful recovery. They did offer to take him, to try a ventricular drain, but stressed this would be to prolong duration of life, not improve the quality of that life.

As we pulled the tube, and placed him on his side, I'm left to reflect: two sets of lives ruined, and not even lunchtime. Difficult to put a spring in my step today.

30 DSC Day 3

3: Song That Makes You Happy

Marvin and Tammi: Ain't No Mountain...

30 DSC Day 2

Day 2: Least favourite song.

Odd phrasing. The song I like the least, or a song I dislike..?

I choose the former.

I'm still not sure.

Of the songs on my 25 most played list, I think I like this one the least.

Which is not to say that I don't like it. Maybe that's not the point.

Van Morrison: Wild Night

Interlude

Been pre-stacking the blog with songs, so listening to a lot of music; not necessarily a smashing idea in my current mind set, but there it is.

Found this again. Stunning version. Would kill to be able to sing like this.

(Vid not so hot, but bear with it...)

30 Day Song Challenge 1

This is going to be problematic, looking at the list; there's considerable overlap in my choices / options, and i"m not sure I can answer them all.

Anyway.

Day 1: Fave song.

Currently... Joplin's Little Girl Blue.

So beautiful it unmans me every time I hear it.

This Might Be Interesting...

A meme I've only just come across...

day 01 - your favorite song
day 02 - your least favorite song
day 03 - a song that makes you happy
day 04 - a song that makes you sad
day 05 - a song that reminds you of someone
day 06 - a song that reminds you of somewhere
day 07 - a song that reminds you of a certain event
day 08 - a song that you know all the words to
day 09 - a song that you can dance to
day 10 - a song that makes you fall asleep
day 11 - a song from your favorite band
day 12 - a song from a band you hate
day 13 - a song that is a guilty pleasure
day 14 - a song that no one would expect you to love
day 15 - a song that describes you
day 16 - a song that you used to love but now hate
day 17 - a song that you hear often on the radio
day 18 - a song that you wish you heard on the radio
day 19 - a song from your favorite album
day 20 - a song that you listen to when you’re angry
day 21 - a song that you listen to when you’re happy
day 22 - a song that you listen to when you’re sad
day 23 - a song that you want to play at your wedding
day 24 - a song that you want to play at your funeral
day 25 - a song that makes you laugh
day 26 - a song that you can play on an instrument
day 27 - a song that you wish you could play
day 28 - a song that makes you feel guilty
day 29 - a song from your childhood
day 30 - your favorite song at this time last year

Best vs Worst

No further rigors, no idea what the source was. Slightly worried I'm harbouring something nasty... but declined investigation so I guess I have to lie in my own bed.

Increasingly find myself gripped by malaise, and dark feelings of hopelessness, which is somewhat self-indulgant considering my situation versus how it could be.

Anyway, blame that for this post.

In general, I have a low opinion of humanity. Essentially, I don't think we're as far removed from the beasts as we like to think we are. Left to our own devices, I think most people will happily crap on their fellow man, if it's to their own advantage.

Altruism, generosity seem to me to be the exception.

La Belle Fille firmly believed quite the opposite; she does have a bright shining soul though. She may be right.

I suspect my job biases me.

Certainly LBF rarely encounters stuff like this: I was wary of telling this story, because it's sensitive, but I've seen it reported in the Daily Mail, which I think makes it common domain.

A young man died recently, and he probably didn't have to. Maybe it was his time, but he was awful young. He fell into a pond. The Mail reports he had an history of blackouts; I heard seizures. Semantics, really. If you were very uncharitable, you could argue someone with that history should probably stay away from unfenced bodies of water unsupervised. I assume he was alone.

I could be wrong.

Anyway, he fell in the pond, and was unable to get himself out, likely because he was unconscious. It took 25 minutes to get him out. No-one would go in after him.

The Mail is quick to chastise the EMS, whose bosses won't let them go in, in situations like this.

But someone called the ambulance. People stood about and watched. No-one, no-one even tried to get him out.

Stood and watched him die.

Music Nazi recommends Eccentric Soul: The Prix Label.

Chills

Today, I had a full blown rigor. One minute, I was fine: the next felt freezing, was shivering uncontrollably, and, I'm told exhibited pallor. My pulse was up a little, and my BP. My BM was normal, urine dip blameless. I had, and have no other symptoms.

A day spent sweating under a duvet seems to have restored me.

I don't engage in high risk practices.

I didn't enjoy it.

But I don't like not knowing why?

I hate being unwell. This makes only my second sick day in 12 years, but my temp was 39C, so I figured I was due.

I let you know if I die.

"You shall not pass!"

One of, if not the most difficult things I have to do is watch people die.

This, clearly, is never easy, unless you're a psychopath. (I am not)

Sometimes, it is expected; after all none of us live forever, and so sometimes it doesn't feel so bad. Especially if you can make that passing as easy for all concerned as possible, and sometimes you can.

But sometimes, you have to watch people die in the knowledge that they shouldn't be dying, and worse, that you don't know why they are, or that you can do nothing for them.

Because what we're supposed to do, is stand there, Gandulf like betwixt patient and death. Only sometimes, you're not a wizard, you're an impotent old man, with a wispy beard.

This happened once before when I was here before, in a different time, or a different life. We then, and still do, as far as I know, take dive casualties, as we have a decompression chamber on site. It might have gone.

The problem with decompression illness is that usually you are too sick to transfer, and will die without transfer. I don't know if there's a answer. I certainy didn't that day.

The patient was a young woman, with, probably, The Chokes. It's like The Bends, but involving your lungs, or the pulmonary vessels. It's having a massive PE with the only treatment a massive metal tube, too far away for me to reach.

She was blue, with crushing chest pain, hypoxic, hypotensive, dying.

I knew why, and I knew I could do nothing about it.

I've never felt so sick.

Then she got better. It was nothing to do with me. she just got better. I guess the gas emboli in her pulmonary vessels just... broke up.

Maybe God looked over my shoulder, and felt our pain.

Death passed us by that day, and I still don't know why; maybe that's best?

What song best describes your life right now?

Darkness on the Edge of Town - Springteen; or:
Beast of Burden / Fool to Cry - The Stones

Couldn't pick one

Ask me anything

More MGCTv

Some problems with the previous link..?

You can find my chums meandering rambles HERE

MGCTv

Attention!
For those of you with an interest in movies, games, comics or TV series, let me advert you to an up and coming podcast. The cast of 3 fellas and one girl provide pleasantly informal reviews and attendant banter. While their tech occasionally betrays them, it's early days, and the general vibe - of listening to some good friends chat about stuff - is just what this Doctor ordered. You can find them HERE, or search MGCTv on iTunes.

Get involved; you won't regret it.

The Black Dog Returns

I once again find myself wrestling with the Black Dog; posting may be affected

I Believe I Have Transcended...

Irony:

The best thing about living alone, is living alone.

The worst thing about living alone, is living alone.

Funny, eh?

Hard Times...

Sometimes shit just happens.
I know this to be true, and mostly use it as a defence, to protect my fragile mind, but sometimes, sometimes, things leak through. No man is an island, and this man certainly isn't a rock.

The Christmas period was as horrendously busy as I've ever seen it, and I've worked a few Christmases. The rest of the hospital seems to operate a fingers-in-ears policy; interestingly, a few weeks after Christmas, when all the patients we'd seen had been admitted, and the burden of care was shifted up a level, 'they' sat up and took notice.

Suddenly we were flooded with extra staff, and, as is so often the way, they came on a day when we had precious little to do, having admitted all the sick patients in the area.

Until, of course, after 6 p.m., when everyone goes home.

Except, me.

We've seen a lot of very sick folks in their 20s and 30s, with awful, awful pneumonias. At first I though it was all 'flu related; the histories seemed to fit, and indeed some of them tested positive, but more of them are testing positive for strep. pneumoniae, which I haven't seen before.

Anyway, this shift, the BatPhone went off, twice in quick succession, forewarning of 2 such patients; one slightly older, one younger. The older of the two arrived first, and looked o.k-ish, just confused, in a lights-on-no-one-home sort of way.

The second, a young 'un, looked really sick. All numbers awful, half-dead in the bed already. I had to take no. one to CT, so left her in the more than capable hands of my Registrar and the ITU team.

No. one's CT checked out ok; I'm still not sure what was going on there, but when I came back, no. two had active CPR ongoing. The guys had been trying to site a central line, when her BP dropped from bugger all, to fuck all. A subtle, but important distinction.

Well, we worked as hard as we could, for as long as we could, but nothing worked, not even a flicker.

I hate losing the young ones, especially when I'm not sure why.

The conversation with her dad, was as hard a conversation as I've ever had.

Cases like this leave no-one untouched. They spread ripples of shit everywhere; they can destroy families, and ruin perfectly good clinical staff, like the Reg I left in charge of the case, who is more than capable, but will be asking himself what more, what else he could have done for weeks.

Maybe it's selfish to think of ourselves, but we can't help it.

We're not supposed to lose these ones, and it hurts.

It hurts, but I suppose it's not so much the falling down, as the getting up again afterwards.

Do you ever regret choosing Emergency Medicine? Does the quiet life of a GP ever seem more appealing?

Never; I wanted to be a General Surgeon (or a trauma surgeon) but since the K doesn't really have dedicated trauma surgeons, and general surgery is effectively an historical speciality, EM was the obvious next choice for me.
I'm not clever enough to be a GP

Ask me anything

In your capacity as a doctor, what's the most unusual condition you have seen?

Toxic epidermal necrolysis, probably. Though I have, of course, seen the usual complement of objects lodged in body cavities

Ask me anything

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Ask me anything http://formspring.me/DrShroom

Laws of Large Numbers

Every now and again, something unusual happens.

Of course, this, at least in part, depends on your definition of unusual.

One-in-a-million?

Sounds pretty unusual, but in the UK, that might be as many as 60 times a day...

So maybe it just seems unusual; or maybe, as a great philosopher once wrote, "It's not unusual"

Nonetheless, it is a truth universally acknowledged that patients collapsing in Radiology have,usually, just fainted, sometimes as badly as Gillian McKeith. (Or, "Gillian McKeith" to give her her full medical title.)

So, today, when the Resus doors banged open and he was wheeled in I was not unduly concerned.

Shows what I know.

To be fair, he did look worse than the usual fainter, and his thready pulse and agonal respiration pattern did little to reassure us. Even that meagre effort didn't last long, and his light went out. There was surprisingly little fanfare.

His history, gleaned in shouted snatches between the requests for adrenaline and flushes, demands for pads and tubes, added little. But we did get him back, and after a prodigious bout of vomiting, he declared himself better.

Well, he didn't know he just survived a VF cardiac arrest brought in by a substantial STEMI.

In fact, one almost wonders how he'd have fared if he HADN'T gone to the pub and fallen over.

But he came back. I still don't know how long he'll stay this time, but he came.

Unusual, eh?

Something...

I want to say that sooner or later, everybody reaches a crossroads in their life. But actually, I guess life is all about the crossing points.

When it gets difficult, where it gets runny is when you realise not everyone is pulling in the same direction. In this respect, I seem to suffer from intermittent empathy failure. Work has been really tough of late; really tough. And it continuously feels like we're being left to get on with it as a Department, to do whatever we can, and take all the blame when shit hits the fan (which it increasingly does), and should there be any goodwill to dole out... well, let's just say it doesn't come our way.

Abandoned Luncheonette; Track 4

I believe I may begin again.

Reasons may, or may not be obvious.

More later