Pics

First few pics are from Healey Dell

The next two are from the park behind Hollingworth Lake

May the Force be with you

Excerpts, from case notes

"Impression: af-attack" FY1, gen med

"On examination, abdomen distended due to fat, soft and non-tender, mainly fat." SHO, gen med

"Patient proceeded to assault fellow colleague with half-a-cup of calogen." FY2, gastro

"ATSP - SOB. Patient has gone out for a smoke; I will review her later when she is really SOB." Med SHO on nights

"If the nurses want another cannula they can put it in themselves." FY1, gen surg

"Dx: ???, refer to medics." ST1, A&E

"Systemic review: c/o pain eveywhere. Pain radiates everywhere else. Morphine helps." FY1, gen med

"GCS 15/15. Patient obviously confused. Not orientated to time, place, or person" SHO, A&E

"Dx: Patient fell on his kness after going to the bathroom and couldn't get up. Wife does not want him to go home as this may happen again. Plan: Refer to medics." SHO, A&E.
*Comment from fellow colleague: Maybe he saw God? And maybe his wife is afraid he'll see "Him", again tonight.

"PmH: Osteopenis." FY2, acute med

"Nurses think she's malingering. I think so too." SpR, acute med

"Symptoms have fully resolved. ? Stroke." ST2, A&E

"Please rule out TIA." GP

"ATSP - Has severe leg pain. Patient asleep. Not easily rousable." Med SHO on nights

"I have been asked to request a 'Head x-ray' for this patient who has apparently fallen. I do not plan to do so." Med SHO on nights

Congenital Defect

Sometimes, I think, I try too hard.
Perhaps I cannot comprehend,
Where I stand in all this,
Always asking, if this is my part?
Do I sit and stare, silently,
From the stiff back of this chair?
Or do wallow into the struggle,
For it's not my way, to fight, or grapple.

And then later on, I wonder,
Why did I even bother?
I should let someone else care,
But it nags me, this feeling,
Like someone, tugging at my hair.
It distracts me, drags me,
Maybe from where, I really ought to be.
It annoys me, confounds me,
Like a (bastard) bee that can't be bothered,
To go after nectar, or make some honey.

And when I try to take a breather, I wonder,
Why (the hell) go through all the trouble,
When I can just look away,
And under my breath, mumble.
When I can turn around,
And pretend to take a tumble.
When I can feign deafness, or stupidity,
And if needs be, perhaps, even insanity.
For you may have been told, as I have,
That one, most unfortunately,
Cannot force, serendipity.

Later on, I discover,
That all that time spent, in 'wonder',
Is now well and truly, lost, forever,
'slike an artist who regrets,
That final, unnecessary stroke.
Or the pianist who misses,
That one, crucial, note.
And the thoughts of these, will always linger,
For sometimes, in life, when you falter,
There's no option to, 'try again later'.

And yet I cannot help, but wonder,
Why I put myself, through all this torture.
Is this what they call, 'cause and effect'?
No, I believe it's due,
To a congenital defect.

Attempted Suicides

If there's one thing I hate about medical on-calls, it's the number of attempted suicides I see. Every single time I've been on-call I see at least one attempted suicide, almost always with pills. Except for that one person who drank a pint of anti-freeze. And that one person who gulped down a shitload of bleach. Both died. It's sad really. There are far too many people who are depressed, or think they are depressed. There are far too many idiots who think that taking an overdose of whatever tablets they have at hand is a quick and painless way to die. For those of you who don't know, an overdose is slow, painful, and stupid way to die.

A chappie I clerked who had overdosed on venlafaxine asked me what pills were best for suicide by overdose. Continue reading:

Chappie: What kind of tablets should I have taken doc?

Me: None.

Chappie: I knew you were going to say that.

Me: Then why did you ask?

Chappie: Well, I was hoping that one of you doctors would be helpful for once.

Me: Let's just say I'm not the best person to ask about suicide. Wrong profession. Also, if I told you how to kill yourself and someone overheard, do you have any idea at all how much paperwork I'd have to do? As it is, I already have to clerk in every single person who comes in with an overdose.

Chappie: I'm sorry for causing you all this trouble doc.

Me: It's quite alright. Do you have any other questions?

Chappie: Do you think jumping off a bridge is a good idea?

Me: No. Unless it was a very high one, and one where you'd be assured of a very hard landing. Otherwise, you'd just give my surgical colleagues a shitload of work trying to put you back together.

Chappie: Oh. *nervous laughter* Sounds painful.

Me: What would be even more painful would be seeing your four children and wife around your bed when you did wake up. And maybe finding some body parts missing. Yours that is.

Chappie: *laughs* I really appreciate you trying to make me laugh.

Me: I didn't try. I did. You want to hear something else that's funny?

Chappie: Yeah?

Me: You're way to old to take an overdose. Please don't do it again. It's almost embarrassing.

Chappie: *chuckles* Thanks doc.

Me: The nurse will come to do a tracing of your heart in a bit. Don't go anywhere.

Later on, at the nurses station, with a cup of coffee.

Nurse: I overheard you talking to him just now. *points* Did he ask you what the best way of killing himself was? If I was you I'd have told him to hang himself. These people waste all our time.

Me: Like I said, wrong profession. 'sides, the rope would have broken anyway, he weighs more than a hundred kilos.

*laughter*

Greying

So there I was minding my own business and checking blood results. Nurse sits down beside me and starts chatting to the ward clerk when suddenly...

Nurse 1: My Gods, you're greying, doc!

Me: Huh?

Nurse 1: There and there and there! *points at my head repeatedly*

Ward clerk: *leans over for a look* She's right, you've got lots of grey hairs.

Me: Em... I've had grey hairs since I was 14.

Nurse 1: Really? How come?

Me: Dunno. *resumes checking blood results*

Ward clerk: How old are you doc?

Me: 23, plus a few months.

Nurse 1: Really? And you have all those grey hairs? I'm almost 50 and not a single grey hair on my head.

Me: Uh huh. *logs on to the PACS system to look at radiographs*

Nurse 1: Maybe you should dye your hair?

Ward clerk: If you cut your hair short enough they won't show so badly I suppose.

Me: Yeah.... but I like my grey hairs.

Nurse 1: Why?

Me: Well, grey hairs are a sign of wisdom.

Ward clerk starts laughing and Nurse 1 just looks confused.

Ward Sister: Chris, what he's trying to say is that you're not wise.

Me: What?!!!

Ward clerk: He's got a point Chris, you ARE pretty immature.

Nurse 1: I didn't catch what you were saying, something about wis...

Me: No no no no no. Let me clear this up. *speaking very quickly* I didn't say you aren't wise. I was merely implying that you're most likely not as wise as I am. *simultaneously grabbing my stethoscope and getting off the chair as quickly as I can* Goodbye, see you tomorrow. *runs away before nurse can make a reply*

Memorable conversations

"You want career advice? Listen up then. You don't want to do acute medicine. Otherwise you'll end up like me. Fat and unhappy."
-consultant, acute medicine

"The MRCP PACES is a good exam to pass, but a very bad exam to fail."
-staff grade, acute medicine

"You're a bright young thing aren't you? Go type something into Google and come up with a diagnosis."
"It doesn't work that way..."
"It doesn't?"
"No."
"Well, do something."
-consultant, respiratory medicine

"When you get to my stage, you'll find out that everything causes everything else."
"Really?"
"Well.... eventually."
-registrar, cardiology

"You know, in life, many, many people will tell keep telling you about all the things that you're doing wrong, they'll keep harping on all the crappy things that you've done, and you can be sure that they'll belittle you at every opportunity. My job right now, is to tell you that you're a brilliant doctor for your age, and you're doing just fine. We all screw up. Your job, is to make sure that you screw up as few times as possible."
-consultant, anaesthesia

"What's that you're reading?"
"Renal physiology."
"Ah, you know, I never really understood renal physiology until just before my fellowship exams. I had this one amazing lecture during a course and everything clicked and suddenly made sense. I don't remember much of it now, but I can remember feeling really proud of myself back then."
-consultant, anaesthesia

"What are you doing down here?"
"I work here!"
"Oh."
-consultant, gastroenterology

"The idea is that if you can maintain a reasonable frame rate... did I just say frame rate?"
"You play pc games?"
"Looks like you do too."
-registrar, anaesthesia

"Damn it, I'm damned if I do and damned if I don't. I think I'll go have a fag and think about it."
-staff grade, acute medicine

Parting Shot

I was on-call the weekend, covering the medical wards. Of course, as soon as I sit down with my cup of coffee the bloody pager goes off. I pick up the phone and call, sigh, another venflon to put in, 'We need it now if you could, her meds are overdue'. I sip at my coffee. It's still too hot to drink. No doubt by the time I get back, it will be cold or some over enthusisatic neat-freak would have poured it down the sink.

So I head over to the ward to find out who the lucky person is. 'You'll have a right job with her doc, we can't get anything into her,' the disgustingly cheerful nurse says to me while nibbling a cookie. I see a steaming cup of tea on the desk in front of her. Sigh.

I walk into the supplies room and gather my things. Tourniquet-check; alcohol swab-check; syringe-check; saline flush-check; micropore tape-check; gauze swabs-check; dressing-check; venflons, venflon, venflons, venflon.... hmmm, we only have these new closed-system venflons here. C'mon, c'mon, where are the good old-fashioned venflons? Darn. None.

So I grab my tray of stuff, a pair of gloves and a sharps bin and head over to the patient. Elderly lady, overweight, oedematous. I shall refrain from using other, more descriptive adjectives. Liver failure, alcohol abuse, self-inflicted. About a million people in the UK fit the description. But this lady, I'll remember her for life.

Now, these closed-system venflons are a new thing. They minimize the chances of you getting a needle stick injury from your own carelessness, but I find them more clumsy to use. Sure, I won't prick myself with the needle, but I may have to poke a patient several more times simply because these things are just a little bit fiddly and harder to maneouvere, especially when the veins are almost thread-like, like in this lady.

So I go through the usual routine and get my stuff out. Tourniquet on the forearm, looking for a vein, looking, looking, looking, looking, and rudely interrupted. "You're rather young for a doctor, have you put many of these in before?" Yes ma'am, although I sure haven't put in as many venflons as you've had tots of whisky, I am pretty good at this. I didn't say this of course. My 'professional-courteous-kind' mask is on. 'Well, I hope you put it in the first time, the last doctor was really experienced but she couldn't get any into me until the third go. I was really hoping she'd be the one to do it today". Yes, well, you're stuck with me unfortunately, and me with you. Looking, looking, looking, found one! Yes!

Swab, wait for it to dry, venflon out, sharp scratch ma'am, "Owwwwww, what ARE you doing, feels like a blade going in," that's because a venflon needle is really a tiny blade with a hole in it, "it didn't hurt this much the last time, Owwwwww...," whatever, flash-back in the venflon, needle out 3 millimetres, advance the cannula, slide needle out and 'click' as the locking mechanism snaps into place and the whole thing should just detach and... WTF? I pull at it a little harder, but the bloody thing refuses to budge. Most unusual. There was definitely a click. I tug at the needle again, keeping a firm hold on the cannula. It still won't budge. C'mon, c'mon. I release the tourniquet with my other hand and keep a firm hold on the cannula while I try to remove the needle and the locking mechanism, won't work, no, this can't be happening, no, no...

"What ARE you doing there young man? Have you got it in or not? If it's in stop fiddling with it! The last doctor didn't fiddle with it! NURSE! NURSE! Come and give this doctor a hand, he's not doing much good!" You fat overweight turd, wtf do you think you're doing shouting your head off like that someone with your vitality shouldn't be in a hospital bed damn venflon why won't you work stupid stupid thing detach I say and let me get away from this...

"Doctor are you ok? Is something wrong? Oh, it's one of those new things isn't it, I hate those, can never get them to work properly. Is it in though? Ah yes you've got it in but what, sorry, you say it won't detach? Let me try, hmm, it seems to be stuck fast, I think you might have to put a new one in, let me try again, hmmm, your call doc," no don't go away, no, help me dammit, sigh. She disappears out of the bay.

No, I refuse to put a new one in. I may not be able to find another vein as good as this one. Point-blank NO. I tug again as hard as I can at the bloody thing and it still won't budge. WTF is wrong with the bloody thing? "WELL? Have you got it or not? If you haven't stop fiddling around down there and get someone who knows what they're doing. My arm's getting stiff." Well fuck your arm and fuck your stiffness and, brainwave hits me, the device is held in place by what appears to be a screw mechanism, I get a good firm hold on the locking mechanism and give it a good twist, and joys, the bastard device finally decides to let go. Note though, that you're not supposed to twist it, the whole thing is supposed to pop off when the needle is locked in the device, i.e. when you hear the 'click'.

Bungs on the venflon ports before they bleed, no such luck, blood flows freely and onto the pillowcase, compress the vein dammit, why won't it stop bleeding, no matter, bungs in place, dressing out, and on the venflon, flush out, and into the cannula, and yes, finally, hurray, hurra-"You've made a right mess haven't you? The last doctor was much better, no fiddling about and certainly no mess like the one you've made, you've gotten blood everywhere, you're certainly, CERTAINLY, not as good as the last doctor."

'Ma'am, I may not have been as neat as the last doctor, I may not be as experienced as the last doctor, but I CERTAINLY, CERTAINLY, ONLY, needed ONE attempt to get the cannula in. As you said, the last doctor, despite her skill and experience, needed three goes before she got one in.'

"Well, you're MUCH ruder than the last doctor as well, she didn't speak to me like that. She was much gentler and nicer, and it didn't hurt as much as when YOU tried...", well go and boil your head you old geezer I didn't have to try, I did it right the first time. I pick up my tray and sharps bin and the assorted pieces of refuse and walk out of the bay as quickly as I can...

"I CERTAINLY HOPE YOU KNOW WHAT TO DO NOW THAT YOU'VE PRACTICED ON ME!"

Stupid, ignorant, illegitimate-daughter-of-a-dece-, nurse walks into the bay to change the pillowcase with blood on it and I hear, "Does that DOCTOR know what he's doing? He seems RATHER young for a doctor, he was fiddling about for a AWFUL long time, and my arm's all sore now..."

And my coffee was cold by the time I got back to the doctors' room on the acute admissions ward.