So, after agreeing to work Saturday, then quietly grumbling about it under my breath, like a passive aggressive chimp, I tripped up to La Maison Belle Fille. I wasn't much use Saturday evening, barely able to stay awake for dinner, and frankly I'm not sure I was much better Sunday, but at least it was more fun.
We schlepped down to a local pub for lunchtime, to sample their sandwiches, which LBF had described as 'amazing', a term she is fond of. They weren't bad after all, but I'm not sure they were amazing. Still, one man's meat, and all that...
We picked up Schlingo on the way. She is always good company, being as prone as I am to outbursts of rage, and not afraid to speak her mind, which I respect greatly. Which made it all the more amusing when a phone call from her boss spooked her into accidentally answering the phone, then hiding it in her bag.
Ensconced in the pub, we turned our attention to the serious matter of the day: a game of Scrabble. The girls are Scrabble geniuses (genii?) so I tried to put them off by flooding the pub with smoke from the wood burning stove; on reflection this was always doomed to failure, and didn't endear me to the rest of the pub's denizens.
We were also joined by JazzMan, whom I like very much, tho' his and Schlingo's relationship is more complex than it should be, which is a shame.
Predictably, Scrabble was won by Schlingo, with LBF in close second, and Jazz and I bringing up the rear. Schlingo was gracious in victory, a fact I forgot when getting a question right during a game of Trivial Pursuit. It turns out no-one else like my 'victory dance'
Smug dance notwithstanding, a good time seemed to be had by all, although I probably drank a bit too much Guinness.
Ah, well; here's to more Sundays by the fire, with me struggling to make the word 'Cat'.
Monday, January 18, 2010
Sunday, January 17, 2010
Stressors
I'm about to start a series of nights; I once again hope for some interesting tales to fill these pages. They may just be my last set of nights, too, so I'd better make the most of them. I should, in the next few weeks, evolve from Registrar to Consultant. (Attending, I think, in the language of my North American cousins)
it is what I have trained and worked for, for all these sodding years. I have sat numerous exams, and slowly seen my mind rareify to the exclusion of all else.
This transition, especially the final passing of my Fellowship exams, should have brought my stress levels down. And those of La Belle Fille. But that hasn't quite happened yet. I guess the effects haven't quite kicked in yet. Or, in the grand way of yin and yang, as my job stress goes down, so La Belle Fille's goes up.
Teaching is a thankless enough task at the best of times, but it seems that at LBF's institution, the grand strategy is to wring as much from your teachers as you can. It isn't enough to have them become good at teaching. They must continue to be good at teaching and absorb any amount of extra-work, curricular and extra-curricular. The parallels between hers and my job are fairly plain. To me, anyway.
But it makes it hard. LBF knows what is expected of her, but has the temerity to want a life outside the school, whereas the school seems to want to syphon all the life out of her.
Is it just her? I think not. Many teachers seem to pull long hours, far in contrast to the stereotypical idea we have of the short hours, and long holidays. Confusing the pupil with te teacher, it would seem.
I'm sure there are plenty of polymaths out there capable of handling all of this, and plenty of folks prepared to dedicate their every waking hour to what they do. I suspect many professions depend on people like that.
But shouldn't there be room for people who just want t be good at what they do?
it is what I have trained and worked for, for all these sodding years. I have sat numerous exams, and slowly seen my mind rareify to the exclusion of all else.
This transition, especially the final passing of my Fellowship exams, should have brought my stress levels down. And those of La Belle Fille. But that hasn't quite happened yet. I guess the effects haven't quite kicked in yet. Or, in the grand way of yin and yang, as my job stress goes down, so La Belle Fille's goes up.
Teaching is a thankless enough task at the best of times, but it seems that at LBF's institution, the grand strategy is to wring as much from your teachers as you can. It isn't enough to have them become good at teaching. They must continue to be good at teaching and absorb any amount of extra-work, curricular and extra-curricular. The parallels between hers and my job are fairly plain. To me, anyway.
But it makes it hard. LBF knows what is expected of her, but has the temerity to want a life outside the school, whereas the school seems to want to syphon all the life out of her.
Is it just her? I think not. Many teachers seem to pull long hours, far in contrast to the stereotypical idea we have of the short hours, and long holidays. Confusing the pupil with te teacher, it would seem.
I'm sure there are plenty of polymaths out there capable of handling all of this, and plenty of folks prepared to dedicate their every waking hour to what they do. I suspect many professions depend on people like that.
But shouldn't there be room for people who just want t be good at what they do?
Saturday, January 16, 2010
Friday, January 15, 2010
Holding The Hot Potato
Being the right man, or woman, in the right place, at the right time... sometimes isn't a good thing.
When Shroom did a brief stint as a Plastic Surgeon, we rotated the days on call on a weekly basis, and the nights nightly. So this meant one week in 5 was pretty Hellish, but that the others allowed for concentrating on elective work, on learning.
But, if you'd just done the day on call and the night guy didn't show... well you were holding the bleep. Right person, right place, etc. No-one really tried very hard to find alternate cover, and damn the fact that it meant you pulling a day-night-day 36 hour shift.
I came in early today to cover a colleague's illness. Internal Cover. A stroke of genius by the NHS. The first thing Ol' Bosso said to me when he saw me concerned the fact that Ill Colleague was due on the weekend as well... he was quick to add that he wasn't telling me this to nudge me in the direction of covering... but: right man, right place.
I was supposed to see LBF this weekend, but not till Saturday arvo, so work can only rob us of a few hours this time.
And, at least this time I'm getting paid for carrying the potato.
(Actually, since I'm only doing Saturday, it's only half a potato really)
When Shroom did a brief stint as a Plastic Surgeon, we rotated the days on call on a weekly basis, and the nights nightly. So this meant one week in 5 was pretty Hellish, but that the others allowed for concentrating on elective work, on learning.
But, if you'd just done the day on call and the night guy didn't show... well you were holding the bleep. Right person, right place, etc. No-one really tried very hard to find alternate cover, and damn the fact that it meant you pulling a day-night-day 36 hour shift.
I came in early today to cover a colleague's illness. Internal Cover. A stroke of genius by the NHS. The first thing Ol' Bosso said to me when he saw me concerned the fact that Ill Colleague was due on the weekend as well... he was quick to add that he wasn't telling me this to nudge me in the direction of covering... but: right man, right place.
I was supposed to see LBF this weekend, but not till Saturday arvo, so work can only rob us of a few hours this time.
And, at least this time I'm getting paid for carrying the potato.
(Actually, since I'm only doing Saturday, it's only half a potato really)
Thursday, January 14, 2010
Harder Than It Looks
Blogging every day. I'm managing to keep up with running (almost) every day - I get a rest day per week, but struggling to find something to write here. So, while I'm thinking, here's another musical interlude. A version of Let It Be, with both album version and single version guitar solos overdubbed together.
See what you think.
See what you think.
Wednesday, January 13, 2010
Tuesday, January 12, 2010
Monday, January 11, 2010
Missed It (2)
A healthy dose of schadenfreude.
A patient with end stage COPD rolled in. She also had a pulmonary malignancy, for good measure. The usual story - gradual deterioration, struggle to manage at home, sudden failure and collapse.
The Ambos reported low sats, recovering with hi-flow oxygen, but a fall in GCS concomitantly.
We see this a lot. I raised my eyebrows, ran the ABG. Acidotic, pCO2 15, pO2 15; both too high, too much O2. Turning it down, we aim for sats in the raange 88-92. Air entry thru the chest is poor, tight. I put it down to COPD, rack up the nebs, quietly confident.
We'll have her up and running in no time.
10 minutes later, I'm wrong. She's gone downhill fast; cyanosed, moribund, circling the drain. Fortunately, the X-Ray fairies have just been, and I gaze at the film.
Pneumothorax.
We know it happens, know they're more common in these guys.
Still missed it.
Still: gives us something to aim at.
Chest tube slides in, a slightly hurried, messy affair, but I hear the air rush out, and five minutes later, the patient feels well enough to complain about the pain in her chest.
I have never been so glad to hear a complaint voiced.
Must try harder next time.
A patient with end stage COPD rolled in. She also had a pulmonary malignancy, for good measure. The usual story - gradual deterioration, struggle to manage at home, sudden failure and collapse.
The Ambos reported low sats, recovering with hi-flow oxygen, but a fall in GCS concomitantly.
We see this a lot. I raised my eyebrows, ran the ABG. Acidotic, pCO2 15, pO2 15; both too high, too much O2. Turning it down, we aim for sats in the raange 88-92. Air entry thru the chest is poor, tight. I put it down to COPD, rack up the nebs, quietly confident.
We'll have her up and running in no time.
10 minutes later, I'm wrong. She's gone downhill fast; cyanosed, moribund, circling the drain. Fortunately, the X-Ray fairies have just been, and I gaze at the film.
Pneumothorax.
We know it happens, know they're more common in these guys.
Still missed it.
Still: gives us something to aim at.
Chest tube slides in, a slightly hurried, messy affair, but I hear the air rush out, and five minutes later, the patient feels well enough to complain about the pain in her chest.
I have never been so glad to hear a complaint voiced.
Must try harder next time.
Sunday, January 10, 2010
Missed It
A lot of what we do is pattern recognition. With experience, our diagnostic process moves from the 'scattergun' approach to the focussed, guided by the signs, subtle or obvious.
Often, we rely on bypassing a lot of 'routine' or standard investigation, if the pattern before us stands out strongly enough. Sometimes the pattern shouts at you. An 'end-of-the-bed' diagnosis.
Of course, not all disease choses to present that way. Sometimes the obvious is not what it appears, and sometimes, perhaps often, the presentation is atypical.
Sometimes it's not.
A young man with a few week history of general malaise. Tired, weak, off his food, weight loss. Even a dose of oral thrush. Three days before, he had taken to his bed, nauseated, vomiting, listless.
He lay on the bed, looking like nothing more than a survivor of Bergen-Belsen. Like cancer, like AIDS.
His eyes were sunken, his tongue dry and sticking to his mouth, his respirations deep, and sighing. Pulse weak, thready and racing.
he'd seen his GP at some stae in his illness. It must have been at the beginning, because no-one cpould pass this off as anything else.
I aked the only question that needed asking. His blood sugar was 52 mmol/dl. He has diabetes, until now undiagnosed, and had drifted slowly into keto-acidosis.
There is satisfaction in even this most simple of diagnoses.
Often, we rely on bypassing a lot of 'routine' or standard investigation, if the pattern before us stands out strongly enough. Sometimes the pattern shouts at you. An 'end-of-the-bed' diagnosis.
Of course, not all disease choses to present that way. Sometimes the obvious is not what it appears, and sometimes, perhaps often, the presentation is atypical.
Sometimes it's not.
A young man with a few week history of general malaise. Tired, weak, off his food, weight loss. Even a dose of oral thrush. Three days before, he had taken to his bed, nauseated, vomiting, listless.
He lay on the bed, looking like nothing more than a survivor of Bergen-Belsen. Like cancer, like AIDS.
His eyes were sunken, his tongue dry and sticking to his mouth, his respirations deep, and sighing. Pulse weak, thready and racing.
he'd seen his GP at some stae in his illness. It must have been at the beginning, because no-one cpould pass this off as anything else.
I aked the only question that needed asking. His blood sugar was 52 mmol/dl. He has diabetes, until now undiagnosed, and had drifted slowly into keto-acidosis.
There is satisfaction in even this most simple of diagnoses.
Saturday, January 09, 2010
Friday, January 08, 2010
Night Fever
Night shifts upon us again; so far, so unbusy. The bulk of our work has come from people slipping in the ice. I briefly debated with Pa Shroom the chances of people curtailing their usual Friday activities (getting drunk, starting fights) in view of the inclement weather.
He thought they might.
They didn't.
I admire that aspect of British resolve; the locals are in no way going to modify their behaviour based on environmenta concerns. Beer exists to be drunk, spouses punched; the big difference is that they then fall over and break something, or, occasionally, freeze to death.
Happy Days.
He thought they might.
They didn't.
I admire that aspect of British resolve; the locals are in no way going to modify their behaviour based on environmenta concerns. Beer exists to be drunk, spouses punched; the big difference is that they then fall over and break something, or, occasionally, freeze to death.
Happy Days.
Thursday, January 07, 2010
Zombie Apocalypse
More evidence, if any were needed, that Great Britain can't cope with snow. And, latterly, that every time I agree to swap shifts with someone, it goes tits up...
Tuesday, two days ago, I should have been on a day off, but had agreed to cover a shift for a colleague. It was the swing shift, 4pm until 1am.
By just after 6 it was snowing pretty heavily, but didn't seem to be settling. By about 8 it was lying thick on the ground, and the flail had begun. Cars were getting jammed on the roads, big and small, and even the Ambos were getting trapped. It rapidly became apparent that no-one who couldn't walk home was getting home.
This clearly included me.
The only upside being that if we couldn't get out, no-one could get in. Ambulances couldn't even back into the Bay, a distance of some 10 feet, up a risible slope, and for a while we either unloaded patients in the road, or relied on 4x4s pulling the Ambos into place.
Just when I thought it couldn't get worse, we ran out of food. Management did their bit and pitched in with a plate of sandwiches. Fortunately, saner minds prevailed and we ordered in pizza...
And then... the power went out. We were, I'm told, struck by lightening. Twice. All the lights went out on majors, and it was all very M*A*S*H - medicine by torchlight. It was at about this moment I was expecting the zombie apocalypse, but the only pallid figures wandering the corridors were the staff.
A few rooms were cleared, and we all bedded down. This was not the sexy night-time hospital orgy it might have been if my life were a film, or if I were not blessed with LBF.
The next day wasn't much better, although numbers were still down, and at least after a double shift the roads had been cleared enough to get me home.
It's still pretty icy out there, and we, as a country still don't really know what to do about it, so the upcoming weekend nights should be a giggle.
Tuesday, two days ago, I should have been on a day off, but had agreed to cover a shift for a colleague. It was the swing shift, 4pm until 1am.
By just after 6 it was snowing pretty heavily, but didn't seem to be settling. By about 8 it was lying thick on the ground, and the flail had begun. Cars were getting jammed on the roads, big and small, and even the Ambos were getting trapped. It rapidly became apparent that no-one who couldn't walk home was getting home.
This clearly included me.
The only upside being that if we couldn't get out, no-one could get in. Ambulances couldn't even back into the Bay, a distance of some 10 feet, up a risible slope, and for a while we either unloaded patients in the road, or relied on 4x4s pulling the Ambos into place.
Just when I thought it couldn't get worse, we ran out of food. Management did their bit and pitched in with a plate of sandwiches. Fortunately, saner minds prevailed and we ordered in pizza...
And then... the power went out. We were, I'm told, struck by lightening. Twice. All the lights went out on majors, and it was all very M*A*S*H - medicine by torchlight. It was at about this moment I was expecting the zombie apocalypse, but the only pallid figures wandering the corridors were the staff.
A few rooms were cleared, and we all bedded down. This was not the sexy night-time hospital orgy it might have been if my life were a film, or if I were not blessed with LBF.
The next day wasn't much better, although numbers were still down, and at least after a double shift the roads had been cleared enough to get me home.
It's still pretty icy out there, and we, as a country still don't really know what to do about it, so the upcoming weekend nights should be a giggle.
Wednesday, January 06, 2010
SnowDay
I have been snowed in at work... Preparing for double shift which will become triple, if folks can't make it in tomorrow... And the hospital has been struck by lightening; So no power. And, I wasn't even on today, but covering for a colleague...
Full details to follow
Full details to follow
Tuesday, January 05, 2010
Short and Boring
About to deploy for work; it is brass monkey cold... not sure I'll have a chance again to update to day, so there's just this.
My NikePlus gear, at least on my iPhone is now working. Frustratingly, I don't know why this is, so can't figure out what was wrong before.
Sometimes I hate being part-Luddite.
Tales of derring-do to folow, I hope
My NikePlus gear, at least on my iPhone is now working. Frustratingly, I don't know why this is, so can't figure out what was wrong before.
Sometimes I hate being part-Luddite.
Tales of derring-do to folow, I hope
Monday, January 04, 2010
The Flail
An unremarkable day at work; started quiet, busied up. The usual. A couple of ectopics being shown round the Dept by one of the Bosses; not sure who they were, or what they do, but I suspect some form of management involvement - another attempt to streamline the Dept, ignoring the bleeding obvious: that we need more space and staff.
At home, my NikePlus kit continues to frustrate me; since my first sensor went dead and I changed it for another, iTunes now seems incapable of linking with NikePlus, refusing me the ability to log my pathetic attempts at running.
I know it's petty, but I need the visual record of what I've managed to help motivate me.
Ah, it's a hard life.
Still no ciggies, btw.
At home, my NikePlus kit continues to frustrate me; since my first sensor went dead and I changed it for another, iTunes now seems incapable of linking with NikePlus, refusing me the ability to log my pathetic attempts at running.
I know it's petty, but I need the visual record of what I've managed to help motivate me.
Ah, it's a hard life.
Still no ciggies, btw.
Sunday, January 03, 2010
Giving Up
I'm trying to give up smoking, again; I don't really want to, but know I should. So I'll probably fail... but we'll see.
It's strange what we will give up, and what we won't, and our reasons behind it. We all make sacrifices of one type or another, and sometimes, I suppose I can't be alone in this, look back and wonder if it was all worthwhile. Have other people made the same choices as I have? Have they had too? Or did they just make better ones?
I don't know. I know how I have justified the choices I have made to myself, and they always made sense at the time, but sometimes, in the dark, alone, 10 years down the line... I'm not so sure.
Morecheerfully, had a grand old dinne with LBF last night, and managed not to act like a twat. The next big choices to make will have to be made together, which represents a departure for me.
Wish me luck.
It's strange what we will give up, and what we won't, and our reasons behind it. We all make sacrifices of one type or another, and sometimes, I suppose I can't be alone in this, look back and wonder if it was all worthwhile. Have other people made the same choices as I have? Have they had too? Or did they just make better ones?
I don't know. I know how I have justified the choices I have made to myself, and they always made sense at the time, but sometimes, in the dark, alone, 10 years down the line... I'm not so sure.
Morecheerfully, had a grand old dinne with LBF last night, and managed not to act like a twat. The next big choices to make will have to be made together, which represents a departure for me.
Wish me luck.
Saturday, January 02, 2010
What Would You Liike Me To Do?
An interesting shift; not as busy as I thought it might have been...
There is,as many of you will know, an ongoing struggle for us in the ED to convince our Specialist brethren that once in a while, we know what we're about.
I saw a young woman yesterday, with a long, complex history; the sort of history that makes life difficult for you - a mixture of physical and psychological, God-given and self afflicted. She has had many admits with belly-ache, and mostly managed with difficulty.
Yesterday she presented a week after taking a substantial overdose of tramadol, complaining of abdominal pain and an inability to open her bowels. So far, so constipation; except that her pan was uncontrollable (which may represent real pain, or simply a desire to obtain more morphine...) her pulse racing, and her lactate sky-high.
Her belly was tight, exquisitely tender, and I called for a surgical consult. The first surgeon I spoke to me told me he thought it all sounded "very soft". You can interpret that any ay you want, but I'm a stickler for tradition, and like my patients examined before their complaints are dismissed as "soft"
The next surgeon's input was limited to asking me what I was doing about the tachycardia?
Well, I've tried agressive fluids, enough morphine to kill a horse, and antibiotics in case she's perfed... I'm kind of stuck; so what I did was... call you.
There is,as many of you will know, an ongoing struggle for us in the ED to convince our Specialist brethren that once in a while, we know what we're about.
I saw a young woman yesterday, with a long, complex history; the sort of history that makes life difficult for you - a mixture of physical and psychological, God-given and self afflicted. She has had many admits with belly-ache, and mostly managed with difficulty.
Yesterday she presented a week after taking a substantial overdose of tramadol, complaining of abdominal pain and an inability to open her bowels. So far, so constipation; except that her pan was uncontrollable (which may represent real pain, or simply a desire to obtain more morphine...) her pulse racing, and her lactate sky-high.
Her belly was tight, exquisitely tender, and I called for a surgical consult. The first surgeon I spoke to me told me he thought it all sounded "very soft". You can interpret that any ay you want, but I'm a stickler for tradition, and like my patients examined before their complaints are dismissed as "soft"
The next surgeon's input was limited to asking me what I was doing about the tachycardia?
Well, I've tried agressive fluids, enough morphine to kill a horse, and antibiotics in case she's perfed... I'm kind of stuck; so what I did was... call you.
Friday, January 01, 2010
Morning!
It's a new day, a new year, a new life?
Who knows. I'll try and update daily, though have my concerns that this may result in short, boring updates.
Like this one.
We'll see.
Happy 2010!
Who knows. I'll try and update daily, though have my concerns that this may result in short, boring updates.
Like this one.
We'll see.
Happy 2010!
Saturday, December 26, 2009
Sorry
Sorry; been quiet too long. I think I'm running out of stuff to say. another brief hiatus follows. Next year, I intend to try and post one a day. If it fails, I think it will be time: I will have run my course. Thank you for your patience, constant reader. I'll see you in 2010
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