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.
Wednesday, November 19, 2008
Friday, November 14, 2008
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.
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.
Tuesday, November 11, 2008
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.
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.
Monday, November 03, 2008
Wednesday, October 08, 2008
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.
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
Friday, October 03, 2008
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-)
Thursday, October 02, 2008
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....
Wednesday, October 01, 2008
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...)
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...)
Tuesday, September 30, 2008
Odds And Sods
Ruminations...
Struggle on, trying to finish some work related research, revise, generally live my life. It goes slowly; I think I'd be good as a sloth. Although not sure I'd pass the entrance exam.
La Belle Fille continues to understand, which is good of her; spent the weekend hanging out, which is good for the soul; I also had the pleasure of seeing possibly the world's biggest round of cheese at the local French market. God love the French.
A brief flag for NotDrRant. This blog has a very different spin on the NHS; a patient's view, and not a complimentary one. I'm in favour of free speech, so you should feel free to check them out, tho' I don't hold with their take on the causes of the faults ( to whit, it's all the doctor's fault. ) That having sad, the author doesn't seem to have been served very well by the NHS.
It raises at least one interesting point. (For a certain value of the word 'interesting') While patients can, almost without fear of censure or repercussion, write what they want about the medical profession, or indeed specific members therof, the medical profession has little, or no, right of reply. So, there is little to stop Mr Smith naming me as, for example, "a cunt", for all the world to read. But if I name Mr Smith as, for example, a wife-beating kiddie-fiddler... the Law has me by the balls.
On balance, I'm in favour of confidentiality. Publishing lists of naughty people all too often results in hysteria, and Paediatricians having their houses shit-bombed; but shouldn't there be some sort of quid pro quo? As a medical professional, I must be completely transparent; I accept this. I must also be inscrutable; I accept this, too.
But should there be some sort of checks and balances to stop my being compared to reproductive anatomy?
Struggle on, trying to finish some work related research, revise, generally live my life. It goes slowly; I think I'd be good as a sloth. Although not sure I'd pass the entrance exam.
La Belle Fille continues to understand, which is good of her; spent the weekend hanging out, which is good for the soul; I also had the pleasure of seeing possibly the world's biggest round of cheese at the local French market. God love the French.
A brief flag for NotDrRant. This blog has a very different spin on the NHS; a patient's view, and not a complimentary one. I'm in favour of free speech, so you should feel free to check them out, tho' I don't hold with their take on the causes of the faults ( to whit, it's all the doctor's fault. ) That having sad, the author doesn't seem to have been served very well by the NHS.
It raises at least one interesting point. (For a certain value of the word 'interesting') While patients can, almost without fear of censure or repercussion, write what they want about the medical profession, or indeed specific members therof, the medical profession has little, or no, right of reply. So, there is little to stop Mr Smith naming me as, for example, "a cunt", for all the world to read. But if I name Mr Smith as, for example, a wife-beating kiddie-fiddler... the Law has me by the balls.
On balance, I'm in favour of confidentiality. Publishing lists of naughty people all too often results in hysteria, and Paediatricians having their houses shit-bombed; but shouldn't there be some sort of quid pro quo? As a medical professional, I must be completely transparent; I accept this. I must also be inscrutable; I accept this, too.
But should there be some sort of checks and balances to stop my being compared to reproductive anatomy?
Surely Shome Mishtake...
| You are a Social Liberal (75% permissive) and an... Economic Liberal (21% permissive) You are best described as a:
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Monday, September 29, 2008
Bloke In A Dress
Casually, and swiftly, photoshopped by a good friend of mine.
I should add that the Shroom does not consider kilts to be dresses, skirts, or, indeed, anything other than manly clothing, especially whn worn 'Highlander', as both I and the Groom were.
I also have nothing against blokes wearing dresses. All power to all people, that's what I say. In fact, it's quite liberating, as long as yo remember to keep your knees together, and avoid scaring children / being placed on the sex-offenders register...
Friday, September 26, 2008
God's Dandruff
Continue in low mood; it is what comes of spending long days alone, at home, ruminating on my own inadequacies.
My impending exam - the Fellowship, the exit exam, the big one... what it takes to be board certified, I think, if you're one of my Colonial brothers or sisters... dwells heavily on my mind. I've spent the last year pretending it was an age away; and know it isn't. I'm not sure where the last year has gone; it seems to have slipped away from me.
There must have been something on my mind (at least for the last 6 months).
Caught a programme on the Beeb a few days ago, about the birth of the NHS. 'Twas interesting, if only to hear the concerns of the (largely) middle class docs regarding the State control of medicine. That the doctor would no longer work for the patient, but for the state. That there would be no autonomy.That we would be told what sort of medicine to practice. Told what we could do and not do, say and not say.
While the GPs were against it, Bevan swung opinion through the influence of Lord Moran, President of the Royal College of Physicians; not by much mind - he only won re-election that year by 5 votes.It wasn't clear what role Surgeons had in all this, but I'm guessing that they too were amenable to having their throats stuffed with gold...
The objections seem to mirror those I see expressed by my Colonial brethren today, when threatened with Socialised medicine, and indeed they would seem to be (at least partly) valid... what was prophesied has indeed come to pass.
Is the NHS a good thing?
Fundamentally, yes it is.
I can't not believe that. People don't die because they can't afford to see their doctor anymore, childhood disease is a shadow of it's former self, and is only really coming back because of the gullibility, stupidity, superstition of certain sections of the populus, encouraged by the media.
Is the Continental system better? The American system? I suspect the practitioners thereof would tell you "yes", but, and I think there's some evidence out there to support this idea of mine, I'm not sure they offer better results per unit spent.
But maybe all that proves is that spending more equals better care... up to a point - see the way China works. But maybe I just don't know any better.
And a man can become little more than the sum of his ideas, his obsessions.
Get it right, and you're a genius. Wrong, a crackpot. We need to be careful about being defined by our own horizons, our own experience.
Consider the American tourist visiting the Bodleian Library in Oxford. Much impressed, she enquired of one of the Security Guards: "This place looks so old. Is it pre-war?"
With a haughty sniff, the Guard drew himself up, puffing out his chest."Madam", he replied, "it is pre-America..."
Does that fit a pre-conception? Should it? Is there any mileage listening to the ramblings of a man who thinks the height of comedy is a Gorilla drumming?
Thank you for bearing with, constant reader. Sometimes I just need to let the mind wander.
More sense soon.
(Or possibly just a picture of me in a kilt...)
My impending exam - the Fellowship, the exit exam, the big one... what it takes to be board certified, I think, if you're one of my Colonial brothers or sisters... dwells heavily on my mind. I've spent the last year pretending it was an age away; and know it isn't. I'm not sure where the last year has gone; it seems to have slipped away from me.
There must have been something on my mind (at least for the last 6 months).
Caught a programme on the Beeb a few days ago, about the birth of the NHS. 'Twas interesting, if only to hear the concerns of the (largely) middle class docs regarding the State control of medicine. That the doctor would no longer work for the patient, but for the state. That there would be no autonomy.That we would be told what sort of medicine to practice. Told what we could do and not do, say and not say.
While the GPs were against it, Bevan swung opinion through the influence of Lord Moran, President of the Royal College of Physicians; not by much mind - he only won re-election that year by 5 votes.It wasn't clear what role Surgeons had in all this, but I'm guessing that they too were amenable to having their throats stuffed with gold...
The objections seem to mirror those I see expressed by my Colonial brethren today, when threatened with Socialised medicine, and indeed they would seem to be (at least partly) valid... what was prophesied has indeed come to pass.
Is the NHS a good thing?
Fundamentally, yes it is.
I can't not believe that. People don't die because they can't afford to see their doctor anymore, childhood disease is a shadow of it's former self, and is only really coming back because of the gullibility, stupidity, superstition of certain sections of the populus, encouraged by the media.
Is the Continental system better? The American system? I suspect the practitioners thereof would tell you "yes", but, and I think there's some evidence out there to support this idea of mine, I'm not sure they offer better results per unit spent.
But maybe all that proves is that spending more equals better care... up to a point - see the way China works. But maybe I just don't know any better.
And a man can become little more than the sum of his ideas, his obsessions.
Get it right, and you're a genius. Wrong, a crackpot. We need to be careful about being defined by our own horizons, our own experience.
Consider the American tourist visiting the Bodleian Library in Oxford. Much impressed, she enquired of one of the Security Guards: "This place looks so old. Is it pre-war?"
With a haughty sniff, the Guard drew himself up, puffing out his chest."Madam", he replied, "it is pre-America..."
Does that fit a pre-conception? Should it? Is there any mileage listening to the ramblings of a man who thinks the height of comedy is a Gorilla drumming?
Thank you for bearing with, constant reader. Sometimes I just need to let the mind wander.
More sense soon.
(Or possibly just a picture of me in a kilt...)
Wednesday, September 24, 2008
Nights Drawing In
I continue in low mood; the 'Black Dog' and I always seem to end up struggling about this time; I suppose if I wanted to, I could call this Seasonal Affect Disorder. It always seems to coincide with the shortening of the days... but, not only do I dislike what I consider pointless labelling (see: IBS; CFS; Fibromyalgia...), but I actually enjoy this time of year; I enjoy the cold, crisp nights and mornings; I'm not quite so keen on getting up, and going home in the dark, but...
I think it is just overpowering nostalgia. Some of my happiest memories are rooted in these months; and I think it just serves to remind me how far I've travelled from them. I miss my friends and my family increasingly these days, and all the more so at this time of year. This year, my mind is troubled with impending exams, and the amount of work I haven't done - some things never change, I guess.
I think this is especially hard on La Belle Fille, who works as hard as I do, for less money and with considerably more organisation; so she finds it hard to see why I should be so stressed, and hard to find ways to help me. And she finds it hard to put up with my bleak moods; the stress isn't good for our relationship, which already labours under the constraints of both our jobs. I know she reads from time to time, so hope she'll manage to put up with my increasingly monk-ish behaviour over the next few months.
Name in lights...
I think it is just overpowering nostalgia. Some of my happiest memories are rooted in these months; and I think it just serves to remind me how far I've travelled from them. I miss my friends and my family increasingly these days, and all the more so at this time of year. This year, my mind is troubled with impending exams, and the amount of work I haven't done - some things never change, I guess.
I think this is especially hard on La Belle Fille, who works as hard as I do, for less money and with considerably more organisation; so she finds it hard to see why I should be so stressed, and hard to find ways to help me. And she finds it hard to put up with my bleak moods; the stress isn't good for our relationship, which already labours under the constraints of both our jobs. I know she reads from time to time, so hope she'll manage to put up with my increasingly monk-ish behaviour over the next few months.
Name in lights...
Tuesday, September 23, 2008
Ever Wondered Why They Called Him "God"?
The sax solo ain't too shabby, either, but nothing beats Eric's guitar face....
Things That Make You Go 'Why?'
Hat-tip to Kal at TQ.
Further details to follow, especially involving La Belle Fille, who was heard to complain that her 'character' appeared to have been written out...
Further details to follow, especially involving La Belle Fille, who was heard to complain that her 'character' appeared to have been written out...
Tuesday, September 16, 2008
My Promises Are Nearly Kept
Saturday was unbearably busy; Sunday just unbearable. It was busy, I was irritable. The SHOs are hard working, God love 'em, but have a deal to learn about the appropriate time to strap on in Emergency Medicine. I'm not sure I helped much.
The tone was set, not so much by Drs Greene or Carter, but by two patients. The first, a young man with his own version of a biological clock; his aorta distended, over-ripe lay swollen and pregnant within him. He knew it was there and had had the 'full and frank' discussion with his surgeon. Weighed the odds of success against the chance of failure and the consequences inherent therein. He had, he thought faced his demons, made his choice, and defended it. The ultimate act of self determination.
Funny how circumstances can change a body's perspective. Each man faces death alone, and sometimes it hurts. He faced death in the company of us all, and asked for one more roll of the dice. We gave it gladly, some less calm than others, but we stood by him.
Snake eyes is still snake eyes, no matter how many hands help roll it.
Number two had other gifts, unknown, only now bearing fruit; spoiled and rotten; foul and terrible. Still I bore them, my words harsh even under the bright lights of the ED. My words, short, to the point, still have the power to bring tears.
Still, the next will be better, eh?
The tone was set, not so much by Drs Greene or Carter, but by two patients. The first, a young man with his own version of a biological clock; his aorta distended, over-ripe lay swollen and pregnant within him. He knew it was there and had had the 'full and frank' discussion with his surgeon. Weighed the odds of success against the chance of failure and the consequences inherent therein. He had, he thought faced his demons, made his choice, and defended it. The ultimate act of self determination.
Funny how circumstances can change a body's perspective. Each man faces death alone, and sometimes it hurts. He faced death in the company of us all, and asked for one more roll of the dice. We gave it gladly, some less calm than others, but we stood by him.
Snake eyes is still snake eyes, no matter how many hands help roll it.
Number two had other gifts, unknown, only now bearing fruit; spoiled and rotten; foul and terrible. Still I bore them, my words harsh even under the bright lights of the ED. My words, short, to the point, still have the power to bring tears.
Still, the next will be better, eh?
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