Slow News Day

Though the moon was bright...

I Never Said That I Was Brave

I'm not entirely sure about this banana...

Cold As A New Razor Blade

I demonstrated, somewhat to my embarrassment, this morning, that after a long night, I am prone to display my primate heritage.

Absent mindedly writing my notes at the desk, I was shakne from my reverie by a coughing from across the desk.

I glanced up. 'Yes?', I enquired.

My SHO trying not to meet my gaze. 'You're... ummmm...'; 'Yes?', quoth I; 'You're... scratching yourself'.

I glanced down.

My hand, unbidden had answered the call of the wild, and I had disgraced myself on Majors, all too in touch with my inner chimp.

iFlail

La Belle Fille has made the jump to the iPhone. (Other phones are available) As with all new tech, there were a few teething problems.

So, shortly after she signed up for it, and whipped it out of it's box, I received a phone call. This one consisted of a few plaintive "hello"s by both parties, and her hanging up. Another call followed, which she hung up as soon as I answered. Then another, which consisted of LBF simply uttering the word: 'bollocks'.

After a few more abortive efforts, it became apparent that she was struggling with the volume controls.

A text followed, asking me to call her, to check that her phone was working. This call passed off without incident, barring much laughter in the background at her end.

The cause: having taken the phone back, and proclaimed it defunct, the phone guy had taken it from her, examined it and then removed the plastic 'screen protector' see-thru label that had been neatly, invisibly obscuring the earpiece of her new, shiny piece of tech.

Simple Joys Unbounded

I can't remember if I've blogged about this before.

If I have, please accept my apologies, and blame the dementia.

A little before Christmas, I spotted an unusual combination. A man in his late middle years, looking utterly fed up, carrying way too much weight, out walking a dog. I wasn't sure it was his, as the two seemed very badly matched.

The dog looked to be a terrier puppy, and had the look of joy unbounded I am prone to attribute to dogs when anthropomorphising them. But he did look to be grinning. He was also full of puppy based energy, and ran everywhere, in a slightly ungainly puppy run - both forelegs, then both hind legs. The man seemed unable to keep up, and simply settled for stopping in the middle of a grassy knoll, and letting the puppy run madly, round and around on the end of an extendable lead.

I saw them again a few days later, the same delightful juxtaposition of their affects apparent.

Best of all, a little later still, I saw them again, simply walking this time, except that the puppy had had a jacket made for it, resplendent in Christmas lights.

If you've never seen a puppy gallivanting the streets clad in a twinkling dog jacket, you haven't known true happiness.

'Nuff said.

Dr Shroom's All-Stars

Final line up:

Vocals: Janis Joplin and Freddy Mercury
Guitars: Eric Clapton and Jimi Hendrix
Bass: John Paul Jones
Drums: Keith Moon
Keyboards: Steve Winwood
Piano: Billy Preston
Brass: The Miami Horns
Sax: King Curtis

Probably...

Medic!

I recently finished a book about the role of the Military Medic. It was well enough written, if a little partisan at times. It was called, aptly enough, 'Medic' and is by John Nicol, Tony Rennell and Eleo Gordon. I would commend it to you.

One of the soldiers detailed in its pages lost his life in the service of his country, and his daughter sang at the 25th Anniversary Memorial service. The song she chose was originally by Steeleye Span, great purveyors of folky-dolky, if you're that way inclined.

Anyway, I uncovered her performance on YouTube, that grand old repository of... well, everything really.

So, a propos of nothing, I include it here. I suggested to La Belle Fille she include it in her singling repertoire, but she suggested it might prove too sad. Or maybe she just didn't like it.

Anyway, I'm not particularly pro-war, but I am pro-soldier, and especially the combat medics, many of whom I trained with, and all of whom have great big brass ones, as far as I'm concerned.

And it's a damn fine song.

Bleak, Bleak, Bleak.... Happy

Another flying visit to La Belle Fille.

We went to see The Road, an unremittingly bleak piece, until the very end. I haven't read the book, but can't help but wonder if the (admittedly only slightly) upbeat ending was influenced by Hollywood.

Or am I just too cynical?

Trust Me...

Trust is a difficult concept. It should have to be earned, and yet I find myself in the position of having assumed trust.

Maybe you don't trust me; why should you, you don't know me? But when yo are ill, when you roll into my ED, you have to take my opinion and advice at face value, and accept that I believe what I am doing is the right thing, that I have weighed up the pros and cons, and made a rational decision on your behalf.

Most people do. Doctors are supposed to be trustworthy; and yet...

One bad apple, and suddenly we are all in the spotlight. Either because he or she was one of us, or because we are acting to silence the prophet, the truthspeaker, who would pull the wool from your eyes.

That's fine. I don't ask that you simply accept what I tell you at face value; I'll give you the options as I see them, and let you make the decision.

What do I know, anyway?

Shameful

Andrew Wakefield.

A disgrace, a charlatan, a mountebanc, a flim-flam artist of the worst kind.

Did he think he was doing the right thing? Does he believe so?

I hope so. History is littered with trail blazers who had to endure the taunts of the establishment, or worse. Maybe he groups himself with those folks.

He certainly has an army of followers who will never believe the worst of him, because they want to believe what he says is true.

But no further research supports his theory; to continue accepting it is a question of faith, faith on a massive scale, and it requires that you accept what he did to children under false pretences was worth it.

I don't, and shame on you if you do.

Maybe there is a massive, worldwide conspiracy that I am, unwittingly, or maybe willingly, part of.

Are you happy that this man had needles stuck into the spinal columns of children for interests' sake? That h paid for blood samples at a child's birthday party? That he never declared his conflict of interest?

Is this how you do business?

Shame on you.

"...Had The Pope And I Not Been Out On The Razz..."

I left the previous post in situ, tho I'm not sure it says very much, except that I am grumpy; and not firing on all cylinders, not at m best.

Off game enough to recuse myself from work? I don't think so. I hope not.

In the aftermath of the Wakefield trial, I want to write something about trust, but it will have to wait.

I'm too tired.

Instead, a teaser from today.

One increasingly finds that the junior staff to whom I refer fail to grasp the point when I'm referring someone I think is really unwell. Unless, of course I use the phrase 'really unwell'. Which I don't like too, unless I really have too.

So, tonight, a poor unfortunate arrived in he ED quite literally spitting blood. He had had his tonsils removed a few days previously, and in considerable pain since... until this evening when the pain suddenly ceased. Unfortunately, this relief coincided with torrential bleeding, presumably from the wound. For those not in the know, the tonsils are anatomically very close to the carotid artery. Bleeding from the tonsillar bed can be catastrophic, not only in its volume, but because its location compromises the airway, and makes it difficult to apply Shroom's Blunt Haemostat. (That is, press on it)

As he rolled in, I was on the phone, pre-warning the ENT SHO of his arrival. When he rolled through the doors, he had two vomit bowl on his lap, brimming with congealing blood, and a steady flow of clots was joining them. I relayed this information to my colleague on the phone, and explained that i thought she and her registrar might want to come see this guy.

She asked a few vital questions (what was his full name, date of birth, that sort of thing), and then casually told me that she and her Reg were reviewing a patient on the ward, and would make their way down when they could.

I told her that was fine, but made her promise to tell her Reg what I'd told her before they went on their ward round, and let him make the decision about which patient was more important.

He was out of breath when they hit the door, two minutes later.

Next stop, theatres.

Anger Management

I occasionally have issues with my temper; this mostly manifests itself in the form of sweary ranting. I returned to work on Monday after a week off, following my last exciting night wherein there was a catastrophic breakdown of the the therapeutic relationship.

This led to an assault on my person, and some inconvenience to my life in general, and has not pre-disposed me to feel good about my fellow humans. Which is unfair. I had a disagreement with one individual, not everyone; but I have found myself more grumpy than usual.

While I feel happy that I have dealt with how I feel about last week's incident, it seems that my subconscious may disagree. I capped my day off by performing a substandard manipulation on a distal radius fracture, requiring me to ask for assistance from the Orthopods; I was then fortunate to meet possibly the rudest Orthopod I have ever come across.

Which is saying something.

I realise it's not fun for them to have to remanipulate a fracture I should have done better with, but surely everyone has an off day?

Or maybe, just maybe I'm being a bit over-sensitive and grumpy.

High Days And Holidays

Spent the weekend feeling a bit sorry for myself, while trying to have fun with LBF. Sick role avoidance. She had schoolwork to do - for those of you that think teachers have it easy, don't forget the marking. Oh, the humanity.

Anyway, worksheets planned, books checked, we deployed to the supermarket where I fulfilled my stereotype by grumbling and generally acting like a 2 year old. LBF was very tolerant, as usual.

We then whiled away a few happy hours watching a programme called 'Watch Me Showing Off', or 'If I Bend Over You Can See What I Had For Breakfast', or something. There was dancing in it, anyway, but I lost the thread when one of the first dancers elected to wear a pair of hotpants so small they barely deserved the name.

Then Schlingo appeared, just in time for a new horror of a dating programme on ITV, unleashing a volley of commentary so sharply honest regarding the contestants, I was in danger of soiling myself laughing.

And then to pub. Beer was drunk, and I didn't vomit, which you'd normally think ought not to count as an achievement, but the Quad-Cocktail I'm on makes it a bit more challenging. I briefly tried my hand at limbo, but aren't as good at it as I remember. Go figure.

Sadly, at the end of the evening, there was no chicken. Although considering the relationship I have with my gut at the mo', this may have been for the best.

The next day was LBF's Poppa's birthday. A grand spread, much laughter. Good time had by all. LBF was moderately put out, when I suggested she likes the art of conversation. The spark for this perhaps unwise observation was her unleashing a comment, a propos of nothing, about her mum vomiting on her dad. She took slightly against me when I passed comment, remarking that we spent many comfortable silences together.

'Only', quipped I, 'when you're asleep'

While this was not massively popular on the LBF side of the car, my point was slightly proven when, on the return journey, she tried for comfortable silence, and fell asleep.

She may just be perfect.

Wounds and The Wounded

The first, on my upper arm, sort of looks like a love bite, doesn't it. Which is ironic.

The second, demonstrating how far between the seventh and eighth ribs a pair of scissors had been inserted. The patient wept when I told her I couldn't give her i.v morphine, which I found telling regarding her motivation for (repeatedly) sticking herself.

End Of Life Care

A few days ago, a British jury found 57 year old Frances Inglis guilty of murder.

Her case is at once both simple and complex. That she carried out a pre-meditated attempt to kill her son can be in no doubt. She used a fale name to gain access to him (having tried this once before), carried two syringes loaded with heroin which she is said to have injected him with, barricaded the door, and glued the lock shut.

So by the law of the land, this is murder. She killed her own son. She had tried and failed before, she knew exactly what she was doing, and that it was wrong.

Her son, Thomas, was resident in a long term care facility, I believe, having been in a persistant vegitative state since sustaining a head injury jumping out of an ambulance.

She felt keeping him alive was crueller than killing him, declining to believe there was any chance of meaningful recovery.

Should this be considered murder?

Well, that's how the law stands, and as medics, we don't take life. But we're also supposed to alleviate suffering.

In my experience, while a few, very few, patients like Thomas g on to make some degree of recovery, they're never the way they were.

Should we be keeping them alive? Would we have done if he were 90?

I'm not sure I'd want to go on like that, but we can never know what Thomas wanted. And allowing exceptions, however reasonable they seem to be, surely paves the way for 'less' scrupulous 'mercy killings'?

I don't know, but I do believe that taking the law into your own hands isn't the answer. If you feel that's what you have to do, have the full courage of your convictions, like Mrs Inglis, and be prepared for the jail time.

Not There Any More

I was saddened to hear of the death, late last year, of one of my first bosses. Read his obit here.

'Smoking' Joe Cahill was a good man to work with. He achieved a great deal, and mixed with many of the great and good. But, more than that, so much more than that, he was a good surgeon, good teacher, good boss.

He will be sadly missed.

(I don't know why we called him 'Smoking' Joe, as, as far as I know, he never smoked)

Sick Role

I'm not going to teach you very much about sickness behaviour here. There's plenty written by wiser and cleverer folks than I. Try Susan Sontag.

Anyway, as I understand it, and remember that it will actually be considerably more complex than this, the sick role is a sort of contract between individual and society. It identifies the unwell and allows us to treat them aptly, both in making allowances, and in preventing the spread of contagion.

Different people and different cultures have different ideas of what the sick role means. Some people delight in having the way they feel medicalised, so that they have both an explanation, and, if you're a bit cynical, an excuse to act in a certain way.

When I first qualified, the NHS in which I worked had very clear ideas as to what the sick role was. Either you're in hospital, or you're in hospital. This attitude has changed, not only because we're much more touchy-feely these days, but also with a realisation that we could be making others ill.

I don't like being ill, like most men.

In eleven years, I have taken one clinical day off sick. Mostly because I've been lucky enough not to be ill, but also because I resent having to cover for people who are ill, so don't wish to inflict the same inconvenience on others.

However, the last few days have seen me 'forcibly' signed off. And it appears, it doesn't take much for me to slide into the sick role, moping about and generally doing nothing. It's a bit too easy.

So, I'm on a mission to get my shit together. While it's true I don't feel 100%, I've got to stop wallowing.

Wish me luck

The Quiet Darkness

I find myself trapped, so to speak, at home. I am due to be working nights, but have been released from my burden. Surprisingly, I am not happy about this.

Imagine the following,if you will; a young man is brought to your ED, having been discovered unconscious, barely breathing. It is believed he has taken a drug overdose; he is suspected of having certain other medical problems.

On his arrival, he is awake, but raving. He seems incapable of conversation, sensible or otherwise. He is having to be restrained by security staff.

A decision has to be made. He clearly doesn't want to be here, and is making very clear efforts to resist assessment in the ED. Does one say 'fair enough', and let him go, free to wander where he pleases? What if hurts himself? Interferes with other patients? What if something else is wrong with him? If he is on drugs, are they wearing off?

What if his medical condition is one that might inflict itself on you?

So, if he continues to rage, but is only going to hurt himself, perhaps he should be left to get on with it, and the pieces picked up afterward?

Maybe; there will always be at least two ways to handle a situation. The way you did, and a better way, viewed from the future.

Another blogger wrote about the treatment of 'bad' people. 'Bad' is clearly objective, and I've always believed we are not paid to make moral judgements about people. And we shouldn't.

When do we put our own safety above that of our patients? What price the duty of care?

Clearly the above is all entirely hypothetical, and on an entirely unrelated note, I have to take some time off work, and, coincidentally, some fairly unpleasant drugs.

Is It, Like, Out Of It's Socket And Stuff?

Yes.

Hard At Work

It is my wont, being a sarcastic bastard, to mock my colleagues protestations of being busy. It's not that I don't believe them. I'm sure they are busy. It's just that they occasionally deploy the phrase with a subtle undercurrent, as if to imply that we aren't.

"It's not as if", I will frequently mutter, "we're sat around with our feet up, smoking cigars and drinking port..."

Well, it turns out, occasionally we are...