Guilty Pleasures...3

And last: Neil Diamond

Guilty Pleasures...2

Also on my iPod: Natasha Bedingfield

Guilty Pleasures...1

On my iPod: James Blunt.

Separated By Common Experience

Chatting with one of the Paramedics the other night, shooting the shit, and all.

He'd had a bad run the night before, attending to a young patient, in cardiac arrest. Nothing to be done, but run the numbers, mark time and call it.

I could see it hurt him, hit him hard; the knowledge that it were all for naught.

I know just how he feels; I've been there, run the same code, counted the same numbers, marked the same time.

Somehow, this makes it harder to talk about. We share a look, and go our separate ways into the dark....

Ghosts

Do we believe?

I don't know; hospitals are surely the site of more strong emotions than most, so should be primed for supernatural activity. I worked in a hospital years ago that was reputed to be haunted; talk was of strange occurrances, and odd sitings on the first floor. This was the da case floor, and usually occupied at night only by the Resident Medical Officer.

Which, for a year, was me.

I never quite saw anything, though on one night a few lights and a t.v. may have switched themselves on in a room a few doors down. Or, the other staff may have been yanking my ding-a-ling.

Who knows?

Shroom's jury is still out, but the other night, while decamping from my car in anticipation of another happy night shift, I was sure I saw someone lurking in the car park, just out of the corner of my eye. On glancing round, there was, of course, no-one there. I'm sure it was but a trick of the light, reflecting on my glasses.

But, try as I might, I could not repeat the feat.

Until I stopped trying.

Twice more I 'saw' him, and each time, he seemed a little closer to me.

A trick of the light, I'm sure.

Nonetheless, I walked in a little quicker than usual that night.

Ask Me No Questions

One to think about, or not.

La Belle Fille asked me this one. She uses it t see inside the minds of children, or something.

"If someone asks you if you have a pen they can use, and you say 'no' without looking, is it lying?"

Anyone? Anyone? Anyone? Beuller?

Bare Below the Elbow

Another great 'evidence based' piece of guidance, condemning wristwatches and rings to the same bin as ties and white coats.

Personally, I like a white coat, and when I started out was able to get a fresh, clean one from the sewing room daily. Seems like a good idea, no? But cheaper not to, and just fuck 'em, instead.

The idea that disease is caused by organisms, and organisms that can be transmitted by hand seems commonplace now, but is, in fact, relatively new. This doesn't stop the idea that making me roll up my sleeves will prevent nosocomial infection being, simultaneously, clutched at by infection control nurses as the next big thing, and utter cock.

Where does it all begin?

Who is the daddy of cleanliness?

May I propose Ignaz Semmelweis. (1818 - 1865)

In my experience, very few infection control specialists have heard of him; and fewer DoH inspectors. History? Why should we care about the past...?

Alexander Gordon, and Oliver Wendell Holmes both had an idea that sepsis after childbirth (puerperal fever) might be caused by the introduction of 'putrid matter' by the delivering doctor or midwife. Influential practitioners such as Charles Meigs were quick to deny this idea.

Semmelweis however, working at the world's biggest maternity clinic in Vienna, found it hard to deny the evidence before his eyes. Those mothers attended to by medical students had a far higher rate of puerperal sepsis than those attended by midwives.

His suspicions increased when a colleague died after cutting his finger during an autopsy.

By introducing something as simple as routine hand washing, he was able to slash mortality rates. His work was published, but largely unrecognised by his contemporaries, and it is sad to report he died in a mental institute.

Hand washing, yes. Rolling my sleeves up...? Still waitin' for the evidence.

Belle Of the Ball

Now that I'm posting again, La Belle Fille has not been slow to remind me she is disappointed with the level of her air time. 

Damned if I do, damned if I don't, it seems...

Work commitments, and the impending Noel have limited the time we've been able to spend together, so I don't really have any great tales of 'The adventures of Shroom and Snaily' to report. She is spending much of the weeknights backstage, in make up this week, which I find endlessly entertaining.

Anyway, out of script does NOT equal out of mind.

So there.

Autologous Autosplenectomy

**Rant follows**

Hospital, and thus department, busy as f...eather boas.

Spent more hours than is seemly trying to organise admission of one consultant's patient under the care of another; consultant 2 didn't wanna do it, and consultant 1 thought this was very unfair, but, curiously, neither would talk to the other, preferring to use me as a go-between.

Ultimately, grown men should be above saying "I won't be calling him, but if he wants to call me, I'd be happy to talk to him"...

I left a patient behind today, handed them over, after failing to get anyone to take them seriously; well, it wasn't so much that they wouldn't take him seriously, it was more that the general opinion was "Sure, he's sick, but it's because of (body system looked after by rival speciality)"

Details to follow, but I'm convinced intra-abdominal mischief was to blame, and failed to convince either the KnifeMen, or the Moths. If I'm right, I'm sure they'll try to lay it at my door; for what it's worth, I still think he'd perfed a diverticulum, but God forbid anyone should take my opinion seriously.

Le Shroom: c'est grumpy.

Paranoia Strikes Deep...

Yesterday morning was spent trying to talk down a spectacularly paranoid fella, who, when he wasn't freaking out because he thought he was blue, was challenging my status.

His exact words?

"I'm not being funny, yeah, but I don't even think any of you are real doctors. I mean, you're all wearing trainers, for fuck's sake!"

And The Band Played On...

I have somehow acquired another follower; which serves to remind me how remiss I have been of late. Well, if you'll keep the faith, I have no excuse.

I undertake to get of my arse, and keep my end of the bargain again.

Starting tonight; promise...

(And, yes, I've back-dated it; I'm cheating, for reasons I will explain. It's sort of my version of the Kobyashi Maru)

"I Dressed The Wound, And God Healed Him"

First in an occasional series of my personal medical heroes.

Ambroise Pare practised in the 16th century; he came from a family with strong surgical connections: his brother was a Master Barber-Surgeon and his sister married one. He served on the House at the Hotel Dieu for a few years, but appears to have been too poor to pay the barber-surgeons union dues, and joined the Army.

Gunpowder had been deployed on the battlefields of Europe since the 14th Century, and had completely changed the pathology of wounds received there. The military surgeon, was, at that time, of a mind to treat gunpowder wounds in a way designed to destroy the 'poison' such wounds were thought to contain. The 'obvious' way to do this was through extensive cautery, or by pouring boiling oil into the wound.

Pare, however found himself forced to improvise; having run out of "oil of elders, mixed with a little theriac" (which was applied boiling t the wound), he was forced to use an alternative - "a digestive made of egg yolk, rose oil and turpentine"

On reviewing his patients early the next morning, he found those on whom the digestive had been used in an altogether better state, and resolved "never again to so cruelly burn the poor wounded by gunshot"

He also went on to describe the technique of ligating blood vessels in the context of amputation.

Highs And Lows

Back, at least for a while. I had intended to wait a day or two, to refit my life all at once; but this idea came to me, and I felt i ought to write it before I lost my mojo again.

I am become a creature of the twilight; lates and nights stalk my rota, and I've forgotten what a normal day looks like. I'm sitting among the detritus of my life that late shifts bring, drinking rum, if that helps.

Sometimes, I feel like we make a difference; sometimes I'm sure we don't. But I guess we try anyway.

The first comes early; or late, depending on which end you're starting from. The shift is a swap, and horror often seeks you out on a swap. Whatever Gods look down ensure that no good deed shall go unpunished. Actually, the shift had been fine. I'd been cloistered in Paeds and Minors all night, my most challenging case a complex nail bed injury; some poor fella's thumb transformed into an horror of pulp. I spend an indecent amount of time trying to put it back together before admitting defeat and sending him to see Plastics.

I look up, and it's seven in the morning. The department is pretty quiet, and I allow myself the thought that I might get away on time.

The phone rings, and the shrill tones gently nudge my adrenals. The sound of that ring is embedded in my cortex, somewhere, along with crash bleeps I have known, all of which still exert a Pavlovian pull on me.

Enough. The story is bad, telling a tale of a young patient hit by a van, not breathing. I have to push selfish thoughts, the knowledge that I'll be late away out of my mind.

We wait. The department seems to take a breath, and hold.... on.....

Then the Ambos arrive, and it's let out in a gasp. Our patient isn't breathing either, and not tubed - the crew are double tech, and no doc able to attend. We lift him over, and I see his colour for the first time, pale and waxy. It is the absence of colour, that in my experience means all his blood has left the building, so to speak. It is always a bad colour, and in trauma, and in the young, spells disaster.

He is not breathing, and we call for the Intensivist.

10 seconds later, it is worse; his heart is not beating. The ECG monitor glares at us, the flat line telling me what I already know. He's bled out, his heart empty.

Blunt trauma, cardiac arrest. Only his youth stands on his side; but I know it won't be enough.

I struggle, briefly, with the tube. Not long enough to make a difference to him, but enough to unsettle me; when the Intensivist arrives, i stumble over my words; this has gone runny really quickly, and I am, as ever lucky to work with a cool, efficient team.

I decompress both chests, to prove the lungs are up, hunting for blood, not finding any. We drill into his shins, cut into his groins, filling him full of blood cold from the fridge. His pelvis and thighs feel stable, and I still can't find his blood. We slide a needle into the thin sac around his heart, and tap 10 mls or so out. SonoSite tells me there's no more there, and that his belly is full of fluid, in this context, the blood I've been searching for.

I look around; an hour has passed, and we've replaced his volume, pumped his chest, pumped his lungs.

It has done no good.

We all know it. I ask for dissenting opinions, and there are none. We make eye contact, one last time, a gentle shake of the head. My day is done now, and I won't be able to see his family, to tell them how hard we worked, how hard we tried. I leave the department unable to meet anyone's gaze.


The next day; the same phone. An elderly patient, bellyache and low blood pressure. The ?aneurysm. During the day, the Department is that much busier, the waiting isn't the same. At night, you may become the focus for h whole department, everyone coming to help, or at least rubberneck. On a day like today, everyone has enough to be going on with, and the only breath holding is done by me.

He arrives, awake and groaning. We lift him gently over, and I see his colour for the first time, pale and waxy. At least he's still talking to me. The Ambos belt out the history, of an hypertensive, elderly patient, 2 day history of worsening abdominal pain, now going to his back and groin. They couldn't feel an aneurysm, but the history and the pale, sweaty patient in front of them meant they didn't need to.

I feel it right away. It's big; too big, I suspect for the Paramedic to have found it; but, to be fair, the Surgeon, who arrives within seconds, is also skeptical. The SonoSite, showing a seven cm mass convinces him. Big lines, a trickle of fluid and some morphine kit our fella up, and we run to theatre. I love theatres out of hours; long corridors, deserted, with odd trolleys stacked neatly, promising work to come. We deliver our patient, and I'm pleased to see how quickly everyone else gets going. Surgeons, Gasmen, Intensivists. I miss this life.

As we leave, I look at the clock. 30 minutes have passed since he hit the trolley downstairs. I don't know whether I should feel proud of this fact, but I do. My good mood is improved immeasurably when one of the nurses skids on a wet floor while trying to open the door to resus. I should add, she didn't fall, or hurt herself, but the effect was hilarious. After she's skated past me, I look at the floor of resus; I'm struck by how similar success and failure are in what they leave behind.

Before I leave, word comes down that he made it out the other side, and there's a little spring in my step as I leave.

Lest We Forget

In Flanders fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead.
Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep,though poppies grow
In Flanders fields.

It's Back...

Farewell, Farewell

Continue in low mood; work has presented me with considerable flail, more than I ever banked on; more than I need right now... so, I'm not sure I'll be much of an author for a little while. Not long, I hope, but for now, a little hiatus.

Be Well, one and all... until the next time our paths should cross.

Farewell, farewell to you who would hear

You lonely travellers all

The cold north wind will blow again

The winding road does call

And will you never return to see

Your bruised and beaten sons?

"Oh, I would, I would, if welcome I were

For they love me, every one"

And will you never cut the cloth

Or drink the light to be?

And can you never swear a year

To anyone of we?

"No, I will never cut the cloth

Or drink the light to be

But I'll swear a year to one who lies

Asleep along side of me"

Farewell, farewell to you who would hear

You lonely travellers all

The cold north wind will blow again

The winding road does call

(C) Warlock Music; reproduced without permission. Lyrics: Richard Thompson

Thought For The Day

You can't make war in the Middle East without Egypt and you can't make peace without Syria.

HENRY KISSINGER (1923-)

My New Favourite Quote

There are, in fact, two things, science and opinion;
the former begets knowledge, the latter ignorance

Hippocrates

Borrowed from Trick or Treatment, by Simon Singh and Edzard Ernst. I commend it to you.

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....

A Sort Of Open Reply

If only because some good points were made, and, if I have mis-represented myself, then explanation should be public.

I want to apologise for over-egging the pudding, suggesting that No-One, from the aforementioned NotDrRant laid all the blame at the foot of the docs. And I concur, there are indeed some truly awful docs in the system, and rooting them out has been, and remains, difficult.

I don't object, by and large, to swearing. I swear vigorously myself at any given opportunity, and the example I gave may have given the impression that it was an indirect dig, or slight, aimed at No-One. Not so. My complaint was more in general, and I freely admit that No-One has indeed not named any specifics. But sites do exist where people can, and do; and the lack of a right-of-reply remains. My own experience of this is acute. Where patients want something from the health service, often for a relative, that it cannot provide, their anger often vents at the nearest professional, rather than the system. Sometimes this is justified, sometimes not. Some of my patients seem to think it acceptable to call me a "cunt" to my face, to suggest that I obtained my degree "from the back of a cornflakes box", and then complain about how poorly they were treated....

Anyway, if you wanna swear, swear on. I meant no criticism.

On a more general note... will giving all the power to the patient solve the problem? I doubt it. Just as Doctors weren't meant to be administrators, neither were the bulk of patients. Yes, they can vote with their feet; but turning it truly 'private' might have a few unexpected side effects. Are we, the medics, afraid of having our snouts displaced from the NHS trough? Maybe. Bevan, after all, only swung the agreement of the Consultants in 1948 with a promise to choke their throats with gold.

For me? Makes no odds. I work in Emergency. Voting with your feet is rarely an option, and I expect I'd make more money if you paid for service. I'm all for patient power, but it has to be tempered with the knowledge that, just occasionally, I might know what I'm doing, might know better than you what the best treatment is. Currently, I have no financial stake in how you're treated.

Will I give you better care if I do?

(The answer's "no", by the way...)