"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
Friday, July 03, 2009
Tuesday, May 19, 2009
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.
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.
Sunday, March 15, 2009
An observation
I have to now state VERY clearly:
The previous post is an OBSERVATION I made. I was not judgemental and I did not condemn in any way. If you find it offensive go report this to google.
The previous post is an OBSERVATION I made. I was not judgemental and I did not condemn in any way. If you find it offensive go report this to google.
A day in town
Got my lazy ass out of bed this morning to go to the bank. After that, I walked over to one of the two local shopping complexes. This one in particular simply because it has a bookstore. Bookshops are in short supply in Rochdale.
So I take the escalator up to the first floor, walk into the bookstore, and spend a good half-an-hour looking at books before I pick out 3 that I like, spot a copy of Gray's Anatomy on a shelf and impulsively add it to the 3 book stack I already have, head to the counter, pay and walk out with one arm cradling a stack of books and both hands organizing my wallet.
So I walk towards the escalator, and just before I put my full weight on the first step, I glance over the side and see below me...
A fat, I mean really fat, the kind of fat where the person is wider than she is tall kind of fat, woman stuffing her mouth with a cream cake. I see the remains of a froth moustache from her cappuccino above her upper lip. I see a half-eaten jam filled doughnut with sugar icing on the plate in front of her.
Around the escalators in the atrium is a cafe of sorts, and practically every table is occupied. And from my height I have a pretty good view.
Of all the people sitting in the cafe.
And at least half of them are grossly overweight. Obese. At least 30 really fat people sitting in chairs sipping coffee, eating pastries and dying.
Heck, we're all dying, but these people sure are dying a lot faster than I am.
Oh, and look at that woman's ankles, swollen beyond belief, nearly the size of her calfs, attacking a scone and winning. And look at that one, she's taking her tablets before she tucks into her steak pie. (I know its a steak pie because by this time I'm sitting 2 tables away from her with a steak pie in front of me and pretending to read)
And look at the one opposite the lady with the cappuccino-froth moustache, so fat that he can hardly bend over his overly large belly to pick up his paper napkin from the floor. And look at that kid, he can't be more than 11 or 12 and his ass is so big that it is spilling over the sides of his chair and of course, he has to be eating, in his case a chocolate sundae with the candied cherry on the table beside the dish.
And lo and behold, there's one of the security guards, so fat that I wonder if his bulletproof vest and walkie-talkie belt had to be custom-made. So soggy around the midsection that it bounces up and down with very step. I doubt he can walk very far before getting out of breath let alone chase me down should I decide to give his fat ass a kick before bolting out the main entrance.
Sigh. I know there's this fat virus going around. Go google "AD-36" if you don't know what I'm talking about. But this, this is ridiculous. The virus can only account for so many fat people. So, what accounts for the rest of them? Behaviour? Genetics? Bad luck? Some would say that it isn't a sin to be fat, and I'm certainly not saying that it is. One cannot deny however, that obesity is an epidemic, one that may soon be beyond our control. If we are all standing on a line, would you prefer to be on the leaner side or the heftier side? And don't get me wrong. I fully believe that you can be both fat and healthy. It's just that I don't think that most fat people are healthy.
I certainly hope the 15 minute uphill walk from town to my apartment got rid of most of that steak pie.
So I take the escalator up to the first floor, walk into the bookstore, and spend a good half-an-hour looking at books before I pick out 3 that I like, spot a copy of Gray's Anatomy on a shelf and impulsively add it to the 3 book stack I already have, head to the counter, pay and walk out with one arm cradling a stack of books and both hands organizing my wallet.
So I walk towards the escalator, and just before I put my full weight on the first step, I glance over the side and see below me...
A fat, I mean really fat, the kind of fat where the person is wider than she is tall kind of fat, woman stuffing her mouth with a cream cake. I see the remains of a froth moustache from her cappuccino above her upper lip. I see a half-eaten jam filled doughnut with sugar icing on the plate in front of her.
Around the escalators in the atrium is a cafe of sorts, and practically every table is occupied. And from my height I have a pretty good view.
Of all the people sitting in the cafe.
And at least half of them are grossly overweight. Obese. At least 30 really fat people sitting in chairs sipping coffee, eating pastries and dying.
Heck, we're all dying, but these people sure are dying a lot faster than I am.
Oh, and look at that woman's ankles, swollen beyond belief, nearly the size of her calfs, attacking a scone and winning. And look at that one, she's taking her tablets before she tucks into her steak pie. (I know its a steak pie because by this time I'm sitting 2 tables away from her with a steak pie in front of me and pretending to read)
And look at the one opposite the lady with the cappuccino-froth moustache, so fat that he can hardly bend over his overly large belly to pick up his paper napkin from the floor. And look at that kid, he can't be more than 11 or 12 and his ass is so big that it is spilling over the sides of his chair and of course, he has to be eating, in his case a chocolate sundae with the candied cherry on the table beside the dish.
And lo and behold, there's one of the security guards, so fat that I wonder if his bulletproof vest and walkie-talkie belt had to be custom-made. So soggy around the midsection that it bounces up and down with very step. I doubt he can walk very far before getting out of breath let alone chase me down should I decide to give his fat ass a kick before bolting out the main entrance.
Sigh. I know there's this fat virus going around. Go google "AD-36" if you don't know what I'm talking about. But this, this is ridiculous. The virus can only account for so many fat people. So, what accounts for the rest of them? Behaviour? Genetics? Bad luck? Some would say that it isn't a sin to be fat, and I'm certainly not saying that it is. One cannot deny however, that obesity is an epidemic, one that may soon be beyond our control. If we are all standing on a line, would you prefer to be on the leaner side or the heftier side? And don't get me wrong. I fully believe that you can be both fat and healthy. It's just that I don't think that most fat people are healthy.
I certainly hope the 15 minute uphill walk from town to my apartment got rid of most of that steak pie.
Saturday, February 28, 2009
Overworked
Because some bastard colleague decides that the best time to take a few days off is when his frakking team is on-take. And therefore, the two other doctors, who do happen to be around, and have been looking forward to a nice, not-so-busy week, end up doing his frakking job simply because he was a sneaky bastard who figured that he could get away with it.
And end up overworked. Sigh.
And end up overworked. Sigh.
Friday, December 19, 2008
Nurse not happy
'Her venflon's tissued doctor, we need a new one.'
'I know, and I've spoken to the registrar. She's really difficult to get a cannula into. We think she should get as much fluid as possible through the cannula before it stops working.'
'But it's TISSUED, doctor.'
'We know. But it took us 45 minutes to get that one in. It's tissued but it still works fine. And her condition is picking up now. I'd hate to stop her IV fluids right now. Her kidney function is still impaired at the moment. what if she goes back into renal failure? We don't want that.'
'Doctor, I don't know how much they teach you about the scoring system for venflons. That venflon IS tissued. And it has been in for 3 days. It should come out today.'
'The registrar and I have taken a look at it. We think it's fine. It'll last another day we hope. And then we can take it out.'
'Doctor, I'm NOT happy to run any more fluids through that venflon. It's tissued and it should come out.'
'Right. Okay. It's 1740 now and I should have been home 35 minutes ago. I believe Mr Zalaf does a ward round at about 1830. Why don't you let him know what you think. I'll see you tomorrow.'
'I know, and I've spoken to the registrar. She's really difficult to get a cannula into. We think she should get as much fluid as possible through the cannula before it stops working.'
'But it's TISSUED, doctor.'
'We know. But it took us 45 minutes to get that one in. It's tissued but it still works fine. And her condition is picking up now. I'd hate to stop her IV fluids right now. Her kidney function is still impaired at the moment. what if she goes back into renal failure? We don't want that.'
'Doctor, I don't know how much they teach you about the scoring system for venflons. That venflon IS tissued. And it has been in for 3 days. It should come out today.'
'The registrar and I have taken a look at it. We think it's fine. It'll last another day we hope. And then we can take it out.'
'Doctor, I'm NOT happy to run any more fluids through that venflon. It's tissued and it should come out.'
'Right. Okay. It's 1740 now and I should have been home 35 minutes ago. I believe Mr Zalaf does a ward round at about 1830. Why don't you let him know what you think. I'll see you tomorrow.'
Wednesday, November 26, 2008
Thursday, October 30, 2008
Flying home!
Today was a good day. Simply because I'm going home!!!
No ward rounds, no taking bloods, no venflons, and...
No on-calls with frustrated nurses saying "Why haven't you clerked my patient in yet?"
And no need to reply "I'll do it as soon as I can", while thinking: because I have 4 other patients that need clerking, dumbass.
It feels great, being able to do all the jobs on the ward and at the same time being able to think: I won't have to chase up these results tomorrow because I might as well be a million-billion-willion miles away.
I'll blog more from Dubai. Right now, I have to pack.
And thanks for all the comments for the previous post!
No ward rounds, no taking bloods, no venflons, and...
No on-calls with frustrated nurses saying "Why haven't you clerked my patient in yet?"
And no need to reply "I'll do it as soon as I can", while thinking: because I have 4 other patients that need clerking, dumbass.
It feels great, being able to do all the jobs on the ward and at the same time being able to think: I won't have to chase up these results tomorrow because I might as well be a million-billion-willion miles away.
I'll blog more from Dubai. Right now, I have to pack.
And thanks for all the comments for the previous post!
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