So When We Meet Again, Introduced As Friends...

Work avoidance.

Or, dangerously close to stream of consciousness thinking.

Swine 'flu continues to rumble on in the background, although it seems this wave has broken. Now, we wait for the second wave in the Autumn.

BBC4 has run a few interesting 'docudramas' recently, one on the Penicillin story, and, more recently, one on the 1918 'Spanish 'flu' outbreak. Well timed to help keep hype levels cranked up to 11. Except that, being on BBC4, I expect most people missed it.

Dr Crippen offers his thoughts on swine 'flu here.

As far as I can see, pandemics are a lose-lose situation for any Government. Either you 'over-react' and close shit down, and nothing much happens (quite possibly because you closed shit down), and everyone gets cross; or, you 'under-react' and people die, and then people get cross.

It's an interesting time to be an health care professional. This 'flu doesn't seem any more virulent than regular 'flu, which makes over-reaction all the more likely. Unlike in 1918, young, fit healthy folks are not dying in their droves. There has been no cytokine storm.

Will there be?

Watch this space.

Is it possible that, in fact, in 1918, the virus was much as it is today, but that a world freshly riven by war presented potential carriers more susceptible to its onslaught? I can't help but fell that society today, for all its fat, wheezy kids, is healthier than 90 years ago.

I guess we'll see in the Autumn and Winter.

What the desire to keep people at arms length has provoked is a concern that we'll get it wrong. Dr C touches on this far better than I could, but let's be honest, you don't need to be a genius to figure out that telephone diagnosis is DANGEROUS. Especially when your criteria are so vague.

I can only assume that someone, somewhere has weighed up the options: the flooding of the health service by ?'flu patients, versus the occasional death by misdiagnosis, and decided that this is the lesser of two evils.

The needs of the many outweigh the needs of the few?

On Swine Flu

I'm sure most of you will follow the flaming, chaotic bandwagon that is Pandemic Influenza with at least some degree of interest. It seems unfortunate that we are incapable of delaing with such medical stories with any degree of perspective.

It's flu.

I think one of the problems is that most people have never seen, or indeed had, flu. Most people think the common cold id the flu, and so when they get flu, think they're dying.

Yes, there's more of it about, so there are more cases of the complications associated with flu.

It's still flu. A relatively mild, probably quite infectious, viral illness.

And now every bugger with a fever and a cough is being told they have the flu.

I share the slightly anxious feeling some of my medical colleagues have toward the shotgun prescription of tamiflu. And the shotgun diagnosis.

9 million hits per hour on a swine flu advice line. I don't realy understand this. The advice is simple, and well publicised. Go home, stay there, drink plenty of fluids and sweat it out.

Some people aren't happy with this advice apparently. I'm not quite sure what they want. An immediate cure perhaps?

Tough.

And why are we getting our knickers in a twist abou tamiflu, a drug that, at best, seems to reduce symptom duration by 24 hours, out of a 2 week run.

Why bother?

It's flu. Yes, some people die, but rarely healthy people, and there's not an enormous amount we can do.

A few thousand people die from flu, and everyone wants a mask; AIDS is rampant, but no-one wants to wear a condom.

Swine Fever

Contains Nudity. You've been warned...

'So, we've asked the Police to pop round and see you. O.K?'

There are few, if any, times a body will be pleased to hear that. I suppose if you're being forcibly pillaged, you'd be glad of the presence of Her Majesty's Constabulary. But I'd cautiously suggest they wouldn't be 'popping' round under those inauspicious circumstances.

Anyway, how did we end up here?

The BatPhone trilled away; the call slightly unusual. 'Young male, GCS 3, ?swine flu'

For those less in the know, 'swine flu' is the current strain, H1A1, of pandemic influenza. Complex protocols exist for it's management, and more importantly containment. These are hard to enforce when your patient is critically ill. The GCS, or Glasgow Coma Score, measures one's conscious level; 3 is the lowest. It is safe to say GCS 3 suggests critical illness.

The history we had been provided with offered few clues, but more details were forthcoming. It transpired our patient had collapsed in a shop. He had popped in the previous day to brighten the tedium of the checkout girls and boys by proclaiming to all and sundry that he had swine 'flu.

And then leaving.

Today, he had gone one better, striding manfully into the shop, stark, bollock naked.

Skyclad, if you will, possibly in honour of the Solstice.

Nudity is always funny; fact.

Sometimes, not for the reasons you think it is, but it's always funny.

Random nudity is usually enough to create a talking point. Or stop conversation. It gathers a crowd, anyway. Occasionally stops traffic. A well endowed female patient of mine once fled my care, for fear of the Military Police, clad only in a tiny thong. Several taxi drivers stooped at the ED, all asking 'guess what I just saw', all disappointed when I guessed...

In this case, onlookers assembled, and our our Nude Ranger coughed heartily on them all, then passed out in a small pile of his own vomit.

Matron and I met him in the Ambulance; the crew were masked up, and had little more to offer. The decision we had to make was how ill he really was, and might he really have flu. Of any sort.

Our initial assessment was promising: it's hard to explain, but there's GCS 3, and then there's GCS 3; one really is coma'd; the other... you get the feeling that they just don't want to respond. The rest of his obs were normal, and he looked well... just... sleepin', sorta.

A little 'gentle' pressure to the nail bed, to establish his response to painful stimulus, one of the components of the GCS, transformed him from 'flu-coma' man, to angry confused man. A startled naked man with a sore finger sprang, like a 21st Century Lazarus, straining against the restraints designed to stop him falling off the trolley en route.

He launched into what I have come toi think of as the waking coma victim's litany:

'FUCK!'

'Fuck off! Fuck. Fuck, FUCK!'

'FUUuuuuckK OFF!'

'FUUU... Hey, where are my fucking pants?!?'

This erudite conversation dealt with, and reassured that he was no longer in coma, we tried to find out what had brought him, in all his pink glory, to our humble establishment.

Unfortunately, he was trying to figure this out, too.

Waking up, to find a pasty man in green scrubs crushing your finger, and two Ambos in masks leaning over you is not well designed to reset your normality.

He wouldn't fess up to any illicit activity (they never do; I suspect they think we'll shop them), and was confused as to his whereabouts; and the whereabouts of his pants.

He eventually coughed to having smoked some weed that morning, but was sure this had had nothing to do with him proudly patrolling the high street, playing willy banjo and passing out.

In case he had ingested something else, we decided to call his girlfriend.

She was also in, shall we say, an advanced state of refreshment; highly relaxed. More to the point, unable to offer any coherent sentences that might aid in our quest to guess the drug. In fact, she was convinced he was still in the house with her. It was this, slightly frustrating, slightly circular conversation that prompted Matron to suggest we'd send Plod round to talk to her face to face.

Now, I respect the kind of fella who decides he's going to spend Sunday getting ripped to the tits on drink and drugs; indeed, it takes a real effort to get so banjaxed that you tear all your clothes off, and bestride the High Street with your balls swinging back and forth by ten in the morning. But I'd rather you didn't bring it to where I work.

I did feel slightly sorry for his lassy tho'. After being called because a loved one has died, I imagine she enjoyed the prospect of the Boys in Blue at her doorstep less than most.