The Return of The Music Nazi

For your consideration:

Nina Simone The Essential Nina Simone
Fleetwood Mac Rumours (tho shame on you if you don't already own it...)
Richard & Linda Thompson Shoot Out The Lights
Janis Joplin Pearl - Legacy Edition and The Woodstock Experience
David Bowie The Rise and Fall of Ziggy Stardust...

Why I Love Tech...

A pox on iTunes, which took it upon itself to delete several of my Floyd and Stones albums; and no they weren't backed up....

Folk Music Re-'Imagined'

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

Whiter Shade Of Pale

First:

STOP whatever you are doing. (Actually, since that'll be reading this, wait till you've finished the paragraph). Immediately find yourself a copy of King Curtis Live at Fillmore West. Press play. Your life is now immeasurably better. Trust me. Go on. Do it. Now. Then come back. I'll be waiting.

See: Told you so...

Not much to report. What follows is mostly non-medical jib, so feel free to sign out and tune in for my next installment of medical derring-do.

Nights were unbusy, which is unusual. Managers are prowling around, trying to avoid any breach, at any cost, in the final push for Foundation status (ein, zwei, ein, zwei, build an empire...). We are becoming even more unpopular throughout the hospital. It's just as well that we don't care.

Well, to be honest, I do care. The ED has ever been the sick man of the Hospital. Fine. But now our reputation for slipshod work, hasty workups and premature referrals is becoming deserved. Which, frankly, sucks balls.

In other news, I'm back to being insomniac again. A long series of lates and then nights has left my brain refusing to fall asleep until six a.m. I wouldn't mind s much if I could do something productive with the time. But I feel exhausted, so end up spending hours trying to sleep. I'm on a random day shift today and tomorrow, before re-embarking my mission to work only late shifts this month. Something's gotta give.

Lastly, in case you were wondering, I have discovered the worst cup of coffee, in the Universe. My standards are pretty low anyway. My North American cousins sneer laconically at me when it comes to my appraisal of coffee. What seems like perfectly reasonable java to me, barely classes as dishwater to them.

So for me to dislike coffee is rare. While a student, I drank revision specials that sent me into SVT, but kept me awake for two weeks prior to my second year exams. When I was on the House, I'd cane cold coffee to perk up at night. Hell, I'd even mainline freeze-dried granules. Discerning, I am not. I jive on caffeine.

However, Burger King supplied me with the worst cup of coffee I have ever come across. Yes, Burger King. Now I say it out loud, I'm not sure why I was surprised by this. But seriously; it was shit.

What If You Knew Her, And Found Her Dead On The Ground...

**Tumbleweed**

Off work at the moment, which should enable me to fill this with exciting tales of my glamourous life.

No such luck. I've spent the time so far revising for a (mock) exam, which I had yesterday; it passed off without incident, which was nice.

So... no news. With ref to my previous post, and regarding the 'Name That Disease' puff piece, I was initially put out not to score full marks. I only got one wrong, and that was an ambiguous q about male STDs (humph...); however, full marks accords you 'Doogie Howser' status. (feel free to deploy Google at this point...)

Whilst I can't really be arsed to enter a long discussion about how wrong I think it is to pop Doogie at the head of the table, it plainly is. So, I'm happy being HawkEye.

In defiance of my friend and colleague, The CherryPicker, I continue to promote musical "flannel". I have recently encountered The Rolling River Band. Can't hardly recommend them enough. Elements of Dylan, Young, Springsteen, Cohen and Waits. Maybe. Anyway, they sound grand. If your feeling a bit folky, also seek out King Creosote. I dare you...

Get involved, get amongst it, it's all happening....

Hazey Jane

Music Nazi recommends anything by Nick Drake. Only 3 albums in his lifetime, which seems desperately cruel. So, buy them. All.
Five Leaves Left. The first, minimal arrangement. Beautiful.

Bryter Layter. Contains Hazey Jane II, my own personal favourite. Possibly over arranged, but outstanding production values.

Pink Moon. Bleak, understated, tragic. Own it.

A Day In The Life

**Warning - Medical Content May Go Down As Well As Up; Past Performance Is No Guarantee Of Future Return**

I'm up early again. All too often I seem to see the wrong side of 4 a.m. I slept well enough, for a few hours; then, my all too traditional waking in a cold sweat. A bad dream? Not one I remember anyway. I vainly try to go back to sleep. Most days I'll know whether it's going to work within a few minutes.

Half an hour later, I'm up.

Pad round the house, aimlessly tidying a few things away. I spend a few moments gazing out the window. Funnily enough, no other bugger is up yet. All is quiet. I rather enjoy the peace, my horizons limited by the pool of light cast out by my lamp. Except I know it means I'm not sleeping.

I'm able to divert myself surfing for a while. I try to catch up on a bit of reading, but I'm never sure how much I take in in the wee small hours. 0430 and it's time for coffee. I dearly love all things caffeine; a taste for coffee has grown on me, over the years, ad I'm not sure it'll ever leave me. Which is good. I really love the coffee.

I'm just about ready. The cold, dark morning awaits me...

Cold showers are over-rated, but they sure as hell wake you up. It's still proper dark as I leave; full night, with only a few foolhardy souls for company. I allow myself a brief slice of boy racer as I power down the road, tipping the scales at 7,000 rpm, and glorying in the throaty roar of my Sports Penis Extension's engine, before dullShroom regains control. The realisation that there really are very few other bastards on the road slowly dawns as I encounter next to no traffic and arrive at work embarrassingly early. Even more so when I figure out I read the rota wrong, and have come in for 8, but don't start til 9.

Arse.

The morning board round is preceded by the usual rounds of shooting the shit, most notably divulging that one of my SHOs is scheming to get a date with one of the radiographers. I think she's already dating someone, so this promises to be interesting; perhaps I can live vicariously through his exploits.

Proving once and for all that I am a sad old fart, with no life, I figure i might as well work, since I'm here. Number one punter is Polish, and we rapidly discover we have no language in common. Although interpreters are available, commercially, the trust seems reluctant to use them, preferring instead to rely on bilingual staff. Who are never around when you need 'em, and have their own jobs to do, anyway. Still, at least they're cheap. The patient smells of a three day bender, and is restless. He's 'MEWSing' at 5, which means his vitals are deranged. MEWS has replaced a sound knowledge of normal physiology, as far as I can tell. It is no longer necessary for one to look at a patient's obs, and decide if they are unwell or not. No, instead, someone distills the info into a handy MEWS score. Bah Humbug. Whatever his score, I think he looks pancreatitic; the bloods go off, and drugs and fluids go in. We wait.

Next a little old lady, with no real idea of why she is here. Dementia intercedes, making meaningful history taking defunct for the second patient in a row... My first, end of the bed guess is digitoxicity. A vain atempt to show off. I don't think it was right. Eventually we decide on a pleural effusion; the patient helps us along by having a small collection of fluid outwith her lung, and I ask the magicians for their assistance...

A young man offers us his racing heart with no good explanation. I take the easy route and blame his 10 day old son for upping his stress levels. Meanwhile, I'm trying to squeeze in a manipulation of a young girl's wrist, with one of my redoubtable SHOs. We have to do it in our MUA (manipulation under anaesthesia) room. It has recently been occupied by a patient with explosive diarrhoea. Despite a nuclear steam clean, the smell lingers. I'm amazed the patient can't smell it; this nasal insufficiency plays out in my favour a second time, as she briefly ends up with her face in my armpit; never the best of places to be, and not improved by a bout of strenuous tugging on a broken radius. Despite a good old fashioned Bier's block, she still finds uncomfortable, but backs down from her original offer to slap me afterward.

All the while an asthmatic COPD-er flirts with true respiratory embarrassment in resus. She is ably handled by another of our SHOs, but not before spectacularly vomiting. Excellent coverage; professional standard.

Polish guys's bloods lean towards the pancreas. I lean toward the surgeons, and they accept. I am briefly stunned.

We get something of a rush next. The specialist Cardiac nurse, or 'ThromboMan' as I like to call him, tries to monopolise Resus, smuggling in a fella with cardiac amyloid, among other things, and an elderly chap trying to see just how slow you can go. I deny him the chance to own resus by bringing in a young guy in status epilepticus. A tragic case, this young man's life ceased to be his own a few years ago when his blood sugar dropped low enough to provoke seizures, seizures that couldn't be stopped, and robbed his brain of oxygen long enough to leach most of its meaningful function. The patient is accompanied by a carer who assures us he does not have epilepsy, or seize 'normally'. Our efforts to stop these seizures depress his respirations long enough to force 24cm of semi-rigid plastic on him.

His trip to the Doughnut of Doom is uneventful - barely a hint of doomliness. The scan offers no new info, either. This passes to embarrassment when we look at his drug chart, and finally see the raft of anti-epileptic meds, and the letters from Neurologists in his casenotes, documenting his propensity to seizures.

At least we know why he fitted. He wakes, rejecting the tube, and another one is welcomed into the warm embrace of the magicians.

Lunch beckons, ad I leave Resus echoing to the cries of a lady who fell, catching the wheels of her zimmer on an escalator. Now, I know I'm a simple fungus, but I don't think those two particular advances in mobility technology were designed to go together. She has only slightly scalped herself, but sees everything we do as an outrage, loudly objecting to our attempts to examine her. She was still complaining 4 hours later, mostly about the fact that other patients were in the Department, using the toilet, and that she needed diazepam.

My post prandial slump encompassed writing a few sets of notes I had let slide. Resurgent after more coffee, I encountered another very young chest pain, again no evidence of cardiac pathology. My reassurances fall on partially deaf ears, but I know he's feeling better when I encounter him and his partner scarfing Burger King.

Another little old lady, another broken wrist. The redoubtable SHO and I spring into action. Our efforts are less successful this time, despite truly game counter traction from the patient herself; a second attempt is better, but produces the most shameful cast. I resolve to turn to Charnley more closely. My redoubtable colleague and I labour on, past our allotted hour.

And so, my shift that started an hour early draws to a close, 90 minutes late. It's dark again, and it's started raining. But I'm happy.

How fucked up is that?

Music Nazi recommends Wish You Were Here, by Pink Floyd. Do it; you kow you should.

We Interrupt This Broadcast...

Raising Sand, by Robert Plant and Alison Krauss.

Buy it. There's no reason why it should work; but it does.

You won't regret it. (If you do, our tastes are far enough removed that nothing I say makes sense. But you are missing out...)

Ball of Confusion

Frankly I'm a little confused.

Had a grand old weekend, although if I'm honest, was probably a bit too drunk and loud. And annoying. In fact I'm lucky my friends put up with me.

Regardless, we had gathered at a friend's house in the flat east of this grand country of ours. A pre Christmas Christmas party, if you will. I asked the girl if she wanted to come. I did this a while ago, while feeling pleased with myself, or optimistic, or high, or something. I didn't think she'd say yes.

But she did, and so I had contrived to spend 24 hours in her company. I'm not sure I distinguished myself, unless she really likes rude songs sung overly loudly. I was also reminded , if I needed reminding, that I am not a young man anymore. Mostly this reminder came in the form of trying too hard to compete in drinking games. Put in my place by a Mary's Man. The shame of it. Time to hang my drinking hat up next to my dancing shoes.

So I had had plans of an attempted wooing. These seem scuppered when I had remarked how we were an anti-cliche, in that we have dinner, she asks me in for coffee, and then... we drink coffee. Of course, says she. I'd be horrified if you tried to jump me.

Horrified.

Let that one roll around in your mouth for a while, if you will.

Horrified.

No, I can't put a positive spin on it either.

Fair enough, I guess that's cleared that up, anyway. Best behaviour, then.

It seemed to work well enough, although my friends were keen to establish us as a couple. I think it's the novelty factor for them. Drunkeness ensued, in case you hadn't gathered, and I sustained a small, but annoyingly painful head injury. Tried, and failed to stay up for the Hatton fight.

But the morning... the morning brought not only the mother of all hangovers, but an interesting sleeping arrangement. Not planned, I insist. Not since I heard the word horrified, anyway. And while all that went on was sleeping, it was, shall we say, very companionable. Was this my time; a test?

Horrified, you'll remember. Well, I didn't see evidence of horror, but I'm still as confused as a fella can be.

Can men and women be just friends? Even if they're very good friends?

I'm no clearer knowing, frankly.

Last business:
Historical note. I've just watched the Alamo. I'm sure the thing is riven with historical inaccuracies, but one in particular has got my goat. General Houston makes reference to Wellington choosing the battleground at Waterloo. He didn't. While he generally preferred to fight on his terms, on this occasion, Napoleon stole a march on him, humbugged him, if you will, and he had to fight there to stop Napoleon splitting the Allied armies. So there.

Music Nazi recommends What We Did On Our Holidays, by Fairport Convention. Do it. You know you need more folk in your life.

SSM - Studying "Some" Medicine?

While extending my roaming through the blogosphere, a word I dearly love, I have encountered a few MedStudent blogs. Harry talks about his choice of SSM. I am now such an old fart that I'm not sure exactly what this stands for. But I note that dissection is one of the choices.

One of the choices?

Now I really do feel old.

When did this become an option? I can't think of a better way to learn anatomy, and I can't think of a more important cornerstone to medical practice. Granted, I have a surgical bias, but I don't claim it is the most important... just that I can't think of anything that should stand above it.

So, having read the blog, I know realise it's 'Selected' Study Module. I still can't understand the rationale of allowing people not to choose dissection.

Bah Humbug.

And, I still can't grow a fucking Mo'.

Music Nazi recommends Most Likely You'll Go Your Way... by Bob Dylan - original or remix.

My Tears Dry On Their Own

Ranting ahead, and a few housekeeping notes.

Doing a bit of extra curricular reading, I came across a few posts by MonkeyGirl. I apologise for the lack of link at the mo', but my server is flailing... I'll rectify as soon as. The gist runs around a story of a patient dying in an ED after being 'underdiagnosed'. The problems are bilateral - it seems the patient was known to the Department, and had a reputation for being non-compliant, and a drug seeker. (This is how I understand it, and I apologise if I have mis-represented anyone, specifically the Girl Simian). On t'other side, it seems that this ED did not offer a particularly high standard of care to anyone, and has subsequently been down-sized, or closed or something. MG's point centred on the family of the unfortunately dead patient suing for $45m. If I understood, she considers this... taking the piss?

It has provoked some polemic.

This is an old problem, and one unlikely to go away. While a system exists that can be abused - e.g free or subsidised healthcare, for e.g drugs - people will abuse it. People's sense of entitlement seems all too often to find ways to overpower their sense of responsibility, both personal and collective.

I think this is particularly true of the UK. People aren't keen to consider their own 'emergency' in the context of others'. And why should they?

Rationing. That's why.

And people have very different ideas as to what constitutes an emergency for them, as opposed to others.

Yes, I know this is sweeping generalisation. I think that's kindof the point.

As medical professionals, nursing professionals, paramedics, whatever, we seem to have our natural cynicism nurtured and enhanced by our exposure to certain types of people. But if we dare to openly suggest that some people allow themselves to be 'legitimately' classed as ill by the state, allow themselves to slide into a sick role because it might be an easy option, we are pilloried.

Of course there are many folks out there whose lives are ruined by chronic conditions, the effects of which are difficult to see, hard to comprehend, even to so-called experts; but there are equally people out there who make use of the system to live of the state, or feed a drug habit.

We, I mean I, am not suggesting that they are one and the same. But some people allow themselves to become medicalised

And if you have spent years feigning illness, or exaggerating your symptoms to get a quick fix, or a warm bed for the night, or time off work, it makes it a bit harder to take you seriously when you really are ill.

I note that critics of the medical profession have rarely had to deal with manipulative, 'professional' patients; have rarely tried to reason with people who feel that their own unhappiness must be the fault of some internal locus, that absolves them from blame - this ranges from the obese patient who blames all their troubles on some mysterious glandular / hormonal conspiracy, to the man who's bad back prevents him working, but not enjoying leisure time with his mates, to the patient with the unexplainable headaches who chooses your ED over the two nearer his home address, for equally inexplicable reasons.

I don't see the same criticism labelled at banks when they give you a poor credit rating for constantly being overdrawn and defaulting on all your loan payments.

But maybe I'm not looking hard enough.

For every genuine patient, with a seemingly 'dodgy' story and/or collection of symptoms, there's at least one who's motives are not pure. There seem to me to be few other professions that have to spend so much time trying to tell one from t'other.

Cynicism seems almost inevitable; we are human too, are we not. And if we vent from time to time, please don't tell us to get out of medicine, unless you've walked a few miles in our shoes.

Next

I would be sincerely grateful if the press would fuck off, and stop writing ill informed pieces about doctor's pay, posing as factual articles.
The idea that medical salaries have gone up at the expense of patient care is ludicrous. The Government felt that doctors, and specifically Consultants and GPs were not doing enough work and should therefore pay them for the work they did. This, it seemed would equate to large savings. If it seemed fair to pay people for the work they do when you thought that meant a pay cut, how is it now unfair when you discover they actually do more work that you thought, and in fact this has meant a pay rise. This suggests that before now, these doctors were doing that work without due financial recompense. You cannot announce a deal to pay people for what they do, only to try and renege because it transpires these guys and gals work far harder than you realised.

And particularly not when it is MPs doing the carping; a bunch of useless bastards who vote on their own pay increase. (Which is never below inflation, as far as I can see. Oh, and they don't have restrictions on what other jobs they can have... but private medicine is to be discouraged?)

I am a simple Shroom; maybe I've missed the point. But I still remember the glee on one the face of one of my old Bosses, when he submitted his work pattern, as instructed by 'the management' and calculated that he was owed 9 months compensatory rest.

Why should medical professionals not be paid at a level commensurate with e.g lawyers, or dare I say it, bankers?

But mostly, I'd like the press to fuck off.

Housekeeping:
I've added a Reciprocity list to the blog. If you've linked me, and I haven't already, I'll link you. I hope this isn't bad blog etiquette; if so I apologise. If you don't wanna be associated with my rantings, let me know.

And, I have decided. You must all now go out and buy Astral Weeks, by Van Morrison.

Now.

Do it.

You won't regret it. (Seriously)