Abandoned Luncheonette; Track 4

I believe I may begin again.

Reasons may, or may not be obvious.

More later

Shaft-ed

Well, not really.

I am, unusally, pretty happy. I can't really say why - certain details o my life have been embargoed, but ha'e a guess. It'll do ya good.

Hopefully, I'll be able to carry my mood to work, where our lives have become more complex as a film crew try to capture our every move, so now we have to worry about looking good while serving the Public... I am NOT ready for my close up.
Anyway... I can't (obv) get enough of these guys, so here you are...

Whirly Whorl

Grumpy Bastard alert.



L'il Shroom's irritability levels have been tripping off the scale of late. Full Tilt Kozmic Boogie, you might say, if ye were that way inclined.


Why?


Dunno, but I am eternally glad that my colleagues at work are prepared to put up with me. I was especially annoyed this evening with a work colleague, who, it seemed to me was showing scant regard for the fact that I was already an hour late leaving; I have at least enough insight to realise that this was unlikely to be an intentional slight, and that I am attributing altogether too much import to myself, and my own self worth, but it stung nonetheless. What hurts the most is the way that we sometimes get taken forgranted; but I am loathe to foster an "Us and Them" relationship. In any close relationship, the partners are bound to rub each other up the wrong way from time to time, and what should mark me out as (mostly) different from the chimps is how one reacts.


Especially when one is a hypersensitive, moody bugger like me.


Anyway, was grumpy, have ranted, proved to have no grasp of modern verse. Feel better now.







An unusual week for ill folks. The young lady with Boerhaave's is still going on ITU. I went to see her. I felt I owed her. At the very least, I felt I owed her husband; I found I could look him in the eye, and, perhaps more to the point, he could look me in the eye. So, now we wait mediastinitis. My prayers are all I can offer her now. We'll know soon enough.




Next: a man with more than his fair share of rib fractures.

Run over; including, if you can believe it, his head. Initially, very uncomfortable (no, really?) Morphia saw to that, and we mostly goggled at him, thinking how lucky he probably was. Then, we spotted part of his chest moving the wrong way. For the non medical, what I mean is that, for every breath he took, most of his chest moved up and out, as per guidelines. But, some of his left chest resolutely declined that option. And moved in; as if it were being sucked in.Which it mostly was. During normal respiration, the diaphragm flattens and pulls down, while the ribs are pulled up and out by the intercostal muscles (between the ribs). This increases the volume of the chest cavity, lowering pressure therein and encouraging air to move in an 'into the lungs' kinda way.



But, if you disconnect a section, by, say, fracturing several ribs in two places, that section moves with the pressure - so, decrease pressure in the chest, chest wall sucks in.



As well as painful, this is bad for the whole process of respiration. In fact, it's number one on my list of 'Unfavourable Chest Wall Injuries'.





It certainly did nothing for his mood.





But... morphine.





Part of the treatment involves placing a large bore plastic tube between the ribs, so decompress the inevitable pneumothorax, and improve respiration. Not easy at the best of times, it's even harder when the chest is not as... connected as it should be.





So... fentanyl.

When I left, he was remarkably chipper, and gave me a big thumbs up. Well worth it.

Today: forehead versus horse. No contest really, although it did give me ample opportunity to flail, flail and flail again trying to garner assistance in transfer to the Mighty Donut. The injury put into perspective all the times I've palpated a scalp, wondering if I was feeling a step off, fortelling the presence of a depressed fracture. This wasn't subtle. It screamed 'behold! Here I am! The indentation produced by a rapidly moving horses hoof'.

CT showed a fracture through frontal bone and sinus, which, relatively speaking, ain't so bad. She was definitively concussed however, continually identifying her location as such esoteric locations as 'the kitchen', 'Sainsbury's', 'the garden'... anywhere but the hospital really. But she'll be fine, although I can't help but feel it might be a while before she makes any sense.

On a lighter note, I'd like you to consider how you might mime the Horse attack. We theorised that men do it one way, and women another, if at all. Think on it, and let me know, if ye can be bothered.

Can't Find My Way Home

I have a bad taste in my mouth this eve; and not simply because I slept badly, and snored.





Good things continue to brew in the background for the Shroom, but it continues as a work in progress, so... shhh...





As a Doctor, part of the deal, maybe most of the deal, maybe ALL of the deal is being the patient's advocate. With all the privilege it entails, patients expect, deserve, demand that we do our best for them; that we do our best, even when others disagree with us.





And this morning I failed my patient; I missed what would turn out to be the crucial detail in her history, although I did not fail to see how ill she was. But I was unable to convince my colleagues of this fact; allowed myself to be pushed around; I could not convince myself to step up for her and force others to help me treat her.





I find this incredibly frustrating; especially when, as this case did, a patient straddles the day / night boundary. With the dawning of the day, the Hospital stirs itself to life, and suddenly everyone is interested in your case, and mostly in criticising your management thereof.





I'm not sure the delay will affect outcome; but I was stung to the quick, having spent 2 hours trying to attract speciality assistance, to have them phone me and 'pass comment' on the delay I was causing.





Sometimes, I hate my job.





For the record, the case was, I suspect, Boerhaave's Syndrome. The patient presented with abdominal pain, following vomiting. Radiograph showed a pneumothorax, possibly pneumomediastinum, and loculated effusion in the left chest, producing a degree of mediastinal shift.

I never cease to be amazed how quickly my colleagues disavow themselves of potential responsibility; all hail Specialisation.

I promised her husband we'd get to the bottom of it, and see her right. I couldn't look him in the face on my way out.

If I Opened My Heart, There'd Be No Room For Air...

Back On Nights...

Maybe some good news in the personal life of Shroom....

However, what is really cranking my handle at the moment is the ongoing furore about MMR. For those of you disinterested, check here, or thereabouts. I am almost incandescent with rage; however, some of my anger makes me seem decidedly right wing. So what follows is mostly rant, based on some small professional knowledge, but mostly bile.

You have been warned.

Vaccines. Named after the humble cow (vacca) by Pasteur, in honour of Jenner and his work with cowpox. Jenner noticed that milkmaids, while oft afflicted with cowpox, rarely, if ever contracted the far more deadly smallpox. So he experimented, by inoculating healthy subjects with pus from cowpox pustules. The rest, as they say is history. Contemporary records show that people were against such odd behaviour, even then - cartoons depict subjects sprouting small cattle from the inoculations. Fortunately, science held sway.

Does it work? There hasn't been a recorded case of smallpox since the late 70s.

When I was a little Shroom, there weren't so many vaccines about. I had measles, mumps and rubella. It was encouraged, as was chickenpox. If any of you know anyone who has had chickenpox as an adult, you'll know why it's better to have it as a nipper.

Enter MMR. An all in one vaccine to prevent these diseases. Why bother? I had 'em, you probably had 'em... so what?

Because these diseases kill people. Not many, but that ain't much comfort if yours is one of 'em.

And then doubt was cast on the safety of the vaccine. The 'evidence' produced was seized upon by the ever rabid media - in this country at least- and hundreds and thousands of parents voted with their feet. And their children's health.

The problem here is that, as doctors, we have a duty to do what is right for our patients; and if that includes breaking the news that a widely used medication is unsafe, so be it. If I thought the man at the centre of this whole mess was acting in what he genuinely believed was the public good, I'd be less scathing. But I don't think he was.

His research was shonky, and his practices questionable to say the least. And yet the establishment failed in it's duty; the checks and balances, designed to prevent this failed. Medical research is under the cosh a little at the mo', cos it turns out people fudge their research. Well, colour me taken aback. This has always gone on - Mendel almost certainly faked his all too perfect results, and the Thalidomide team hedged theirs in an attempt to prove safety that was to have disastrous consequences.

But now the idea is out there, and there are a number of people who will never be convinced of the wrong-ness of this charlatan's research. Any other evidence will be dismissed as Government cover up; we're back to pictures of cows sprouting from forearms.

But how far can a Government go to enforce the health of a nation? If parents don't want to vaccinate their kids, however ill advised I may think it, can we force them?

Maybe not, but it makes it that much harder to sympathise with the mother who's child is critically ill with pertussis (something I've never seen before either), who explains they decided not to get the kids jabbed after reading the Daily Mail.

By all means make an informed choice, but for Christ's sake, make sure it really is informed.

And The Walls Came Tumblin' Down

I can not bear it...

Last night was not so bad. Better than my last nights. My colleague with whom I was to share the duty swapped out of it. So, flying solo again. Good.

Not too busy, but enough to keep time ticking over. And I feel like I did a reasonable job.

Until this morning, when an elderly fella with a whopper of a scalp lac provoked a good deal of flail. Turned out ok in the end, but I guess I won't be winning any plaudits for how cool I am.

And I was slightly disappointed with one of my SHOs. You know who you are, if you've found me. There has been an air of disquiet of late, as the juniors feel demoralised. Not getting to do enough, not getting enough exposure; fair enough. This job is becoming service orientated; but when the opportunity presents itself, shouldn't you take it? Or have we broken your spirit so, that you really don't care anymore?

We're doin' something wrong.

I still can't bear it.

Once again, we allowed ourselves to dare to dream. The England football (soccer...) team flattered to deceive, and we thought: 'maybe, just maybe...'

As I write, I see mortar flaking down around my ears...

Interlude

I'm in a blue mood today; which is disappointing.

Bad news, bad news, come to me where I sleep.

Had a grand old day yesterday; pottered about at home, actually getting a few things done, which is unusual. Then in the eve, out with an old friend, for a slightly surreal evening. First, multi-national big band jazz, in an historic town. Then we slipped out to a local pub for beer, and encountered an energetic four piece rock covers band. Oh, and a late licence. The pub patrons were an interesting bunch, who really did dance like no-one was watching. Took a bit of getting used to. But a grand old time... except.

My heart is lost. I am infatuated by someone new. Since my beloved left me to the NHS, I have been solo Shroom. It's probably what I deserve. But I am head over heels, intoxicated, can't get enough of her. So, consequently, every time I'm anywhere near her, I fall apart.

I think she knows. And I think she doesn't feel the same way. But maybe...
I guess we're pretty good friends, and I am torn between preserving the status quo, and playing my hand, terrified I'll fall flat, and that'll be all she wrote. But maybe... she's waiting for me to make the first move..? Every time I even think about it, all marrow, all moral fibre deserts me...

I am pathetic. But she is fabulous...

Then today I heard more bad news. It really puts my 'bad news' into perspective. Two of my very good friends have run afoul of the occasional shitstorms that life throws at you. It seems unlikely that either of them read this, but maybe they know someone, who knows someone, etc, who might.

So, no details,

But it's put a real downer on me. I feel oddly disconnected from life. It seems more unfair than usual.

I can only wish them well, and try to be around a bit more for them, for what it's worth.

Lastly, today we remembered the dead. Whether they agreed, or understood fully what was asked of them, they offered a sacrifice beyond what most of us can comprehend. We should never forget.

On My Own... (Again)

I've taken the Queen's Shilling - again. And at what cost? A return to solitude.

My beloved and I have gone our separate ways; can I philosophise about it here? I'm not sure; she might read it, and I don't know how fair that is. Suffice to say, I failed in my duty as 'significant other'. Much as I wanted to, I couldn't give enough of myself to do her justice. I am become a self-fulfilling prophecy, afraid to commit, because I fear the end, but bringing about the very thing I dread most.

For right or wrong, I have allowed my work to dominate who I am. It's difficult to feel good about that a lot of the time, especially when you wake up lonely and alone at two in the morning...

I Wish That For Just One Time, You Could Stand Inside My Shoes, The You'd Know What A Drag It Is To See You...

Again, long time no jib...

Sorry. If any of my dwindling readership are still trying, I'm sorry.

I've been a little distracted of late. Shroom's fallow period has ended.

I have a new object of my affection. And it is mutual! I'm not a stalker. My current squeeze, my babyluv may feature here more later, but not for now. I don't want to jinx it, and I'm not sure I have the right to publish her the way I do myself; yet...

Anyway; I have a few local interest 'pieces' to blog about, but they will follow. They're mostly me grumping about what's happening at work. What follows, since we were talking of stalkers (sort of) is the tale of Shroom's only stalker - to date.

I know I've alluded to this recently, but don't think I've covered the details.

The whole sordid affair took place years ago, when I was a Plastics junior in a London hospital. At the time, I had rotated on to the Burns Unit, which meant I spent my days there, but shared the on call rota with the other SHOs covering Plastics and Burns. One Wednesday night, I took handover, and did my rounds, as usual. On the ward was a patient who had been waiting for surgery for a few days. I'm not sure why he'd been waiting but it was a bone of some contention to him, and he already had a reputation as a 'troublemaker' among the nursing staff.

The duty Reg and I stopped by to examine him, and see if we could get the op done overnight.

As I recall, the history was that this chap had been in a house that had been firebombed, and in trying to escape the inferno, he had gone out of a window, sustaining glass laceration to the dorsum (back) of one hand. On exam, it was obvious that his injury was substantial. There was significant skin loss, tendon and nerve damage. The op would require complex reconstruction and full thickness grafting - well beyond the capabilities of the Duty Reg and I, and as no consultant had expressed an interest in staying on to do it, we had no choice but to tell him he would have to wait another day.

He was not pleased; as we continued on our rounds, I was summoned urgently back to the ward. The fella was screaming and shouting at the nurses. When I went to find out why, he turned his attention to me. His primary complaint was that too much time had elapsed before the replacement of his dressing. He claimed that his hand had been left undressed for half an hour, and he was furious at the thought of it becoming infected.

When I pointed out that we had only left him five minutes before, he changed tack; the most vitriolic stream of abuse followed, the gist of which was that nurse were "bitches in skirts" who should be at his beck and call. He expected them to fetch and carry for him, and, I kid you not, "peel me grapes".

As this, almost laughable, rant continued, Sister attempted to re4place his dressing - made more difficult by the fact that he was gesticulating wildly. It must have been uncomfortable, because he flinched, mid-diatribe, and i saw his (good) fist curl up, and he went to swing at Sister. I did the only thing I could think of, which was to step in the way, and place my hand over his fist.

I suspect, in my mind, I was Clint Eastwood - as the Man with No Name.

This is part the first... I'm mid edit - apologies

Nurse, The Screens!

A morally satisfying weekend educating my fellow medics, as the scramble to get MMC boxes ticked heats up.

I also managed to see Ma and Pa Shroom. I was slightly concerned to hear that Pa Shroom's memory is fading. I'm sure this is, at least in part, because he's retired. When he was working, and I was a student, I was always amazed at his superior knowledge of anatomy - even for those bits he didn't cut regularly. Now Pa Shroom bemoans the loss of this knowledge, and he was telling me his short term memory is failing him too. I hope that's all it is. I couldn't bear to see him dementing...

After my hapless flailing at the fairer sex on Friday, a cheeky note from a fellow Blogonaut brought light to my soul. Thanks again, even if you were humouring me.

As the philosopher Springsteen once wrote, "Don't call for your surgeon, even he says it's too late: it's not your lungs this time, it's your heart that holds your fate."

And to finish, a picture that I 'discovered' this weekend it took my breath away. The essence of human spirit?; or maybe just a young, scared boy running for his life...?