Musings Of A Medical Dinosaur

A work in progress.
Worth reading, to start with.

The wind is changing; has changed. Jane Doe, writing the jib I've tagged above, typifies what I have come to think of as the 'modern' attitude. Respectable papers in such august journals as the Annals of Emergency Medicine are chronicling the decline of the once mighty General Surgery. In part, this is because specialisation makes being a generalist difficult, but, and perhaps this is the greater part, also because no-one wants to work the hours.

Long hours, once seen as the domain of the macho surgeon, are no, it seems to me, increasingly seen as both unnecessary and unfair. Many young Docs, confronted with the sort of punishing shifts once common in the NHS were taken aback. It was not what they were expecting. I must confess I find this hard to credit; it was hardly a well kept secret, and many medical dramas made it a key feature - see The Houseman's Tale, Cardiac Arrest or even ER for reference. Perhaps I write from a privileged position; Pa Shroom was in the business, so I saw the routine 12 hour days, and 1 in 3 (1 in 2 when someone was on leave) he worked - and this as a consultant.

I knew exactly what sort of hours I would be expected to put in.

But if you weren't sure... surely it wasn't that hard to find out..?

The way I see it, the way I saw it... you worked all the hours God sent when you were young, and I will never be that young again, and it got easier as you got older. I was always at work earlier, and later than either my SHO and Reg; I'm sure they worked harder, were cleverer... but I worked as long, if not longer.

Was I tired? Yes, all the time. Did I make mistakes? I'm sure I did. My shroomy pride has blotted the copy-book of my memory clean, but I know I didn't kill anyone. Did I learn anything?

Almost everything I learned, I did on call; often in the darkest hours of the night, often in desperation. Was this the best way to learn...?

I can't say that it was, that it is. I'm sure it's not, but it worked for me; doing my time pulling scut duty taught me the basics. Some might say that putting iv lines in, mixing and starting iv drugs isn't real doctoring. It certainly ain't glamorous, but it's as much the duty of a doctor as anything else. And what happens when the iv techs aren't there, or can't get it?

They call me, or other grumpy bastards similarly full of themselves.

Continuity? Sure, you can never have absolute continuity, but it seemed to work better. It was the exception, rather than the rule that someone on the firm was away, and we all knew all of our patients.

Is the way I learned better? I don't know, but it did work for me, and I know I'm not alone. Is that reason enough? No. To say 'I did it this way, so you have to too', is blinkered.

But it shouldn't be dismissed out of hand either.

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.

Heartwarming

The news today is full of a story concerning an off licence use of Viagra (sildenafil) to further the recovery of a premie baby.

This use is not really news. I'm sure you all know what Viagra is used for now, but it was intended as a drug to lower blood pressure. And it has found use in treating pulmonary hypertension in newborns before.

This provoked much controversy.

I must confess to being unaware of this potential use for Viagra before today, but received the news with great joy. Not just because a baby is alive who might otherwise be dead. But also because it does a little to restore my faith in medicine. There is a grand tradition of using unorthodox treatment in medicine. I remember my first boss reacting angrily when told by a drug rep that he couldn't use a particular medication in the way he did, because it was off licence. He was quite confident in his medical knowledge, backed by many years of experience. He reminded me that Registered medical practitioners are entitled to prescribe as they see fit. I suspect the local formulary has more to say about it these days...

In the 'good old days', I'm sure many unorthodox / experimental treatment was carried out without full consent. While I don't condone this, I can't help bu feel that the pendulum has swung too far the other way. In the modern age of Evidence Based Medicine and protocol driven care, delivered by practitioners with limited knowledge base and experience , there seems to be little room for the use of a medication or treatment for any purpose than the manufacturers intend.

I'm not proposing that patients should be peppered with untested drugs, or at random. But I think we are loosing the part of medicine that was, and is, it's art. The science is stronger than ever, but there should be more to it than that.

Sometimes you have to think laterally.

A Professor of Surgery, under whom I worked when I was an Anatomy Demonstrator wrote this:

And how many of us, having carried out some new and untried treatment, have had this experience of being unable to sleep and of creeping to the ward before anyone else is around, with pulse racing, to see whether the treatment has been a brilliant success or a disastrous failure!*

That was published in 1996. I suspect the answer is 'none of us', now.

So give thanks today, not only for a life saved, but for a flicker of life in the Art of Medicine.

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Operations that Made History, Ellis H CBE; Greenwich Medical Media 1996