Tragedy!

Just read another one of my friends blogs and realised that they are all revising. They've been at it for weeks, the bastards. I sat down to my first hour of revision today. There's about a week to go till the exam, every single day of which I will be at work, including two nights.

The conclusion is inescapable: they will pass and I will fail. I will be terribly sad when I have to folk out another £300 and sit the fucker again in Summer. O why o why didn't I revise a little more? Because I'm tired of sitting motherfucking exams, that's why!

Taming The Beast

I recently decided to have a look at my mate's blog (www.thelostdoctor.blogspot.com) as a kind of substitute for actually meeting up with him since we haven't quite managed to get round to doing that in a while. I have to admit it was an interesting experience. Though I'm quite sure that he's well aware he is writing for an audience and that, as a consequence, his entries must be forged to provide at least a modicum of entertainment, there is still that undeniable leitmotif of dissatisfaction that runs through all that he writes. I know that this at least is authentic because he has spoken about it before when we have actually managed to meet up for a pint and it would genuinely seem to bother the lad. What I sometimes wonder, though, is does he really have the right to so acute a sense of tedium vitae at so young an age?

Leaving aside the job - which admittedly seems to be most of the problem - The Lost Doctor's life is no disaster. He's a well-liked, well-off Essex-lad-done-good with a top-notch bird and well-oiled brain. Let's be fair: he's not really holding a hand full of jokers now, is he? So, why so glum? Well, seemingly because the realisation has dawned that the beast that is Medicine is a genetically-enhanced, soul-destroying machine that would gobble up all your spare time, chew up your life and spit you out at the other side with nothing to show for it but an surreptitious addiction to alcohol, a bitter divorce or two and, if you were lucky enough to have the spare time in the first place, some kids who don't know who you are and are long past caring. Not the brightest picture, admittedly. But the fact of the matter is that medicine is but a job and I don't think that The Lost Doctor is the type to get caught up in the scenario above. That is the fate for people who are consumed by the idea of medicine, only to find it is Medicine that ultimately consumes them. Those whose life outside of Medicine withers to a pitiful appendage on an existence spent in the pursuit of power within it. Those whose idea of some quality social interaction consists of exchanging their latest Venflon story over a half of diet coke before scurrying off to brush up on renal tubular acidosis. They are the people who look back and think: what a waste! The Lost Doctor is not of their ilk; he will survive. If only he semmed to realise is that he is not yet shackled to the beast. If he hates medicine so much (which I don't believe he does), then he need only leave it - he is bright enough and young enough that most of the doors are still open to him. Alternatively, if he feels Medicine is already beginning to finger his hole, then why not just recentre his life outside of it - learn something new and interesting - and force the beast back into its place before it rapes him completely.

Homo cuntus

Just a mini-bitch today about some knobs I had the displeasure of travelling with on the tube home. A quick glance around as I took my seat revealed a pair of overly-preened, browny-orange-faced, tightly-dressed men heading for the seats opposite. Their fluid transition from sitting to seated was terminated by an extravagant Kenny-Everett-style flourish of the legs. These came to rest in that horrible little pose whose purpose was to preserve a lady's modesty and whose assumption is most unbecoming of a man (see pic). If there could have existed any doubt before, that was now dispelled: these were homos of the middle aged variety. Yet this tableau alone, though amusingly predictable, was not quite enough to make me flinch.

Suddenly from within his black Lonsdale leather satchellette (which may possibly be issued at birth to all gay men in the future), one of the homos pulled a large, hard-back book. Opening it on his crossed legs, he immediately assumed the position of somebody reading a work of great complexity and importance. His index finger, itself connected to a limp and flexed wrist, gently fingered the corner of his mouth. His well-plucked eyebows contracted and descended under the effort of comprehension. It was then that I noticed the title of this learned volume: Unlocking The Hidden Spiritual Powers of the Human Mind. Fuuuuuuuuuck oofffffffffffffffffff! What a load of bullshit! Why do people read this crap? And why particularly effete, middle-aged poofs? I can only hope that this apparition was no ghost of Christmas future!

Ladies and gentleman, I give you a new and terrible species: behold homo cuntus!

Your Hospital Needs You!

For those that do not know, medicine is much like the army. At the very top of the ladder is the general, or consultant, who masterminds the entire operation. The consultant is a cerebral creature who loathes getting his hands dirty. (In this he is second only to the semi-mythical Commander-In-Chief, or Professor, whose body has been so neglected in favour of his intellect that over time many have evolved into nothing more than an enormous, glowing brain in a jar which is carried around the wards on a litter by its simpering minions.) A consultant's involvement in the care of his patients is to be limited to the minimum possible: a zero-eye-contact, post-take-ward-round handshake is ideal; a second brief pre-discharge glance is acceptable; but any more interference with his busy golf schedule is liable to bring on an attack of the vapours from which the juniors may never recover. The practicalities of implementing his action plan are of no interest to him; that it be done, and preferably done yesterday, are his sole concern. Indeed, so elevated are the Consultants that they often feel that they have broken free of the irksome constraints of "best practice" or "evidence". Faith is the principle that would seem animate these exalted beings: how many times have I heard my consultants declare that they simply "do not believe" in such-and-such a drug or such-and-such an intervention when the evidence in their favour is overwhelming.

Next come the sergents, or registrars. The registrar is, to many, less of a position than a predicament. It is their misfortune to be the most senior man on the battle field. Whilst the on-call consultant languishs in his leather arm chair at home, the registrar must lead his soldiers into battle against the combined forces of the patient massive and their army of A&E doctors, who will use all manner of lies and trickery to get a annoying patient off their hands and onto those of the medics. Dodging referrals, batting away crusties and calming his panicking and incompetant troops are some of the many balls that the registrar must juggle. As a rule, the closer a registrar comes to promotion to consultancy, the less his soldiers will see him as he retracts from the fray to his GHQ, conviently located in the mess, from whence he can relay his orders by telephone.

On the front line are the the captains, or the senior house officers. Deep within the enemy territory of A&E they toil to clerk the endless list of uninteresting patients. With no hope of any help from above, they watch the referral list grow with mounting distress. In their hearts a dark and bitter place sloshes full of resentment at the privates, or house officers, who, by virtue of a new law called the European Working Time Directive, are more likely to be found in the mess with the registrar than at the coalface with the SHO.

With so little experience, the house officer trembles and quakes at the prospect of A&E. Indeed, should their worst nightmare be realised and some unruly SHO demand their help in A&E, they flounder and flail through the clerking with all the elegance of a cow on an ice rink. The only hope for the unfortunate victim of their inept artistry is that somebody more senior might spot and prevent their deadly errors: the toxic doses of inappropriate drugs; the penicillin prescribed for the allergic patient; or the three litres stat of i.v. fluid pouring into the veins of a 93-year-old chap in heart filure. Then again, as we all know, the only sure way we learn is by our mistakes and what's a few unneccesary deaths between friends.

So, in the future just remember: in medicine, whether you like it or not, you gotta be a team player!

Death Stalks The Wards...In The Form Of The Medical SHO

O what cheer! O what joy! The AMU block has begun. This is the (heavy) price I pay for scarcely having done any on-calls in this job. Now it's pay-back time: an epic, three-week medeley of long-days, weekends and nights spread between A&E, the acute admissions unit and the wards.

I got off to a flying start this weekend, with ample chance to put my Oncology skills to good use. Everywhere I went previously well people suddenly gasped their last and karked it. My mere presence on a ward, it seemed, was enough to send blood presssures plummeting and resp rates rising. Within my 8 hour shift, I made 5 people 'comfortable' (i.e. knocked them out of it with a morphine and midazolam syringe driver); informed 4 families their relatives had taken a 'drastic turn for the worse' (i.e. they're dead); made 2 people not for resuss (i.e. they're about to die and I'm too tired to do chest compressions); and attended 2 crash calls (i.e. assisted in closing the stable door after the horse had bolted).

Well, at least at this rate I'll have the hospital's bed crisis single-handedly sorted in no time!

Snowly: Requiescat In Pace

The Metro, ever-bountiful source of vaguely comical or bizzare stories to keep me bemused on my journey to work, has yet again come up trumps. Today I read about a young Chinese girl who had died after a marathon session playing one of those massively multi-player, online computer games. Extraordinarily, her fellow gamers then held a virtual funeral for her character, Snowly, at which they each took turns to eulogise her.

Now, I'm not so silly as to think that that 'to die after doing something' is exchangable with 'to die because of doing something'. There are millions of high-intensity players on these games and so I suppose the possibility exists that one of them might die whilst involved in it. Instead, what I find amazing is that people were able to bond suffisciently in playing that they felt they knew this character enough to want to mourn her death. Moreover, that the game is complex enough to permit its users to mimick the social rites surrounding death within the game is simply staggering. These would seem to be true virtual worlds, and I suppose it is scarcely surprising that people get caught up in their intricacies. The tasks that have been created to challenge gamers are no longer amenable to completion by a single player on his own. With teamwork a prerequisite to success, the players are reliant on pacts, themselves the product of complex social interactions. By extension, this demands huge chunks of time to be devoted to the game - chunks of time not dissimilar to those one might expect to spend at work. Since one must work to be able to afford to play the game, I can only summise that the these chunks of time are what would otherwise be devoted to 'real' social interaction or sleep. Either way that does not a sound particularly healthy exchange and it's no small wonder, therefore, that the Chinese government is planning to pass a law forcing software companies to build in limits on how long a someone can spend playing their game. I suppose the one counter point here is that for some people the game may constitute their only social outlet and their fellow gamers their only true friends. It's a tragic thought that leads me to wonder whether it could be that more people attended Snowly's virtual funeral than attended her 'real' one?

The Lottery Of Life

I find it strange that after my discourse on the lottery of life, I should have turned on the TV and had to watch a horrible little documentary on a girl with fybrodysplasia ossificans progressiva (FOP) whose muscles are turn slowly turning to bone. Though FOP doesn't look particularly nice, I don't think it actually matters in reality what the name or nature of the condition is. All that really counts is the fact that there are people in the world who have been delt a shit hand. Some hold all the aces; others only the jokers.

Throughout my career, I have come into contact with a fair few children who are condemned to spend most of their lives in hospital and destined to die in their teens or shortly thereafter. Now, it is certain that these children will never leave normal lives. Yet, it is equally certain that in no way could it be said that they will never be happy: they smile; they laugh; they bond and they enjoy just as do others more fortunate. Even so, I cannot help but think that - were there reliable tests for all these horrible diseases that so cripple and curtail and were I solely responsible for the choice - I would not hesitate to terminate the pregnancy. Of course, this doesn't really sit very well with my professedly Utilitarian moral framework. After all, strictly speaking, any pleasure derived from whatever life one experiences is superior to no life at all because no life at all is guaranteed no pleasure at all. (Just to let you know: I don't subscribe to any daft deontological semi-religious ramblings about absolute wrongs and rights - everything in life is relative.) To me, it just seems so cruel for somebody to have to endure a life so shortened and torturous, a life which will never be normal in a society that does not tolerate difference well. To me, despite the smiles and the laughs, these lives seem to be more pain than pleasure - frustrated at every turn - and that cannot be right. The obvious charge is that I only think like that because, relatively speaking, I hold higher cards, and indeed, it must be said, that is a fair charge. Though no Cristiano, I am not being turned to bone by FOP, paralysed by MND, asphyxiated by CF, or destroyed by any other non-sensical arrangement of the alphabet for that matter. Perhaps it is true that, whilst I could never tolerate the loss of everything I have - the health, the freedom, the possibilities - perhaps had I never possessed them in the first place, I would be content to enjoy whatever form of existence I had access to. After all, for me, a life entirely consumed by swimming around in rivers eating microbes and avoiding bigger predators seems pretty dull and pointless, but to a fish, which has never expected or known anything beyond this, it is probably perfectly satisfactory and possibly even enjoyable.

The most trueful answer is that, in all likelihood, their are no glib certainties in issues such a this; only difficult personal choices. So long as we agree that people have the right to make their own choices on these matters, then I am happy to accept these decisions, on no matter what grounds they may have been made. What I cannot accept, however, is the argument that people do not have the right to choose. That is simply not acceptable.

What It Is To Be Beautiful

And who said football was boring? How can it be when you have people like this running all over the field. Isn't he just amzing? Isn't he just the apotheosis of male beauty? Well? Isn't he?

And how extraordinary it must be to be that lucky! Not merely celebrated by innumerable football fans for his ability to be able to manipulate and control a leather bag of air - an idol to little hopefuls all over the world - but also beautiful enough to be a successful fashion model and to be voted most sexy man by his own country's folk. Truely, when they were giving out the gifts, Cristiano must have been pretty close to the front of the queue.

It does make me think of the incredible injustice of the lottery of life when you see people like Cristiano and compare them to some people you might meet elsewhere in life. Some people do seem to have the most awful lives. A physicality that could only have been obtained from scrubbing bogs for most of their lives; a mentality that is the product of a tragic interlectual deprivation; and a social existence that veers between the excruciatingly banal and frighteningly unstable. Mostly, these people have done nothing to deserve their fate save to have been born as who they are, when they are and where they are. Quite frankly, it's a miracle that people aren't more pissed off about the whole thing!

J'accuse...

Sigh. It would seem I have been a naughty boy (see comment on the previous post to find out why). I stand accused of vying with Freddy boy for top the league in arrogance and inhumanity. In fact, in my detractor's eyes, I win outright because mine, alledgedly, is an educated intolerance. These charges arise from my carping on about patients in the first two posts. I feel, therefore, that I ought to write something in way of a defence.

Firstly, whatever Anoymous does to earn their crust, I suspect it is not medicine. Medicine is a very demanding profession that can easily suck the life out of you if you are not careful. In response to this danger, people develop defence mechanisms. One very good defence mechanism is to moan about everyone and everything, and anyone who has ever been in a doctor's mess will know that this is the strategy prefered by almost everybody. Acceptable targets include other health care professionals (nurses for doctors and doctors for nurses is an age-old tradition), management, the government, your seniors, relatives and patients. This is a fact of life - it does not make you any more evil moaning about patients than it would were you a hairdresser moaning about your clients. The simple reason for this is that it does not affect how you actually deal with those people. The whole point of my moaning about people presenting sick on the ward is because, no matter how late I have to stay or how busy I already am, I know I will still see them and try my best to sort out their problems. If I didn't moan about it though I might just explode or, far more likely, fizzle out with a whimper.

Nor just because I moan about people does it mean I don't actually care for or pity them. Humans are complicated things and resentment about work which is vaguely associated with somebody is easily compatible with concern for their well-being and a desire to attempt to fix their problems. As I sit writing this, there are two bottles of wine on my desk from patients to thank me for my care and understanding so I suspect I cannot be that cold and disinterested. That said, in must be recognised that some people are actually not very nice and, especially whilst working in A&E, I have been shouted at, spat at, punched and kicked. And surprise, surprise: I still treated all those people for their medical problems as well, though perhaps without the smile my oncology patients get.

As for my little tangent on relatives hoping for the patently impossible, it was not intented to imply that they were stupid for doing so but to reflect on the innate human capacity to see hope where there is none. In addition, as I pointed out, this deficit or quality (depending on how you view it) is just as obvious in we doctors who occaisionally - and unfortunately - reduce the quality of a patient's remaining life by giving chemotherapy when it is not appropriate because we hope that they might tolerate it whilst everything points to the fact that they will not.

Finally, there is also the fact that what I have written below is also tainted by own sense of humour, which is largely based on exageration and irony (this is an English euphemism for sarcasm, by the way). You surely wouldn't believe that I thought my boyfriend's breathing had 'all the charm of a dripping tap', would you now?

So, in sum, I reserve my right to moan about whoever I want, including my patients, because I know it does not affect how I deal with them. And, like it or not, there is a whole world of difference between moaning about somebody and actively campaigning for the death penalty for them!

One, two, Freddy's coming for you....

Sadly, I did not have time yesterday to mention Pastor Fred Phelps' internet coup de grace. For those who visit www.godhatesfags.com, there is an extra special treat in store in the bottom righthand corner of the main page. There, a small counter keeps track of the number of days that Matthew Shepard and Daine Whipple have, alledgedly, been burning and suffering in Phelps' dantian conception of Hell.

Now, for those whose memories are a little foggy, Matthew Shepard was 21-year-old gay college student who was brutally beaten to within an inch of his life, tied to a fence and left for the elements to leech out the remainder of it. He was found 18 hours later and rushed to the hospital, where he lingered on the edge of death for nearly five days before succumbing to his injuries. Diane Whipple was a 33-year-old lady who was horrifically mauled to death by two out of control dogs, and happened to be a lesbian.

Now, the level of hate demonstrated by Fred in creating these two links is quite staggering. In fact, it has to be seen to be believed, which is exactly what I would advise you do just to remind yourselves how evil people can be. For God's sake (no pun intended), these people died horrific deaths and, whether straight or gay, nobody warrants this kind if treatment. The level of vitriol in Pastor Phelps' summary of Diane Whipple ('she lived like a beast, died like a beast, at the hands of beasts, and is mourned by a family of beasts') leaves one in no doubt that, when it comes to preaching, Fred's is almost certainly of the fire and brimstone variety. However, let no one doubt that Fred does not take his work seriously: anxious that no sinner underestimate the level of suffering set aside for fags in Hell, there are included two methods of hearing how Phelps' fevered imagination would have Matthew pleading with them to avoid his fate. By bringing the pointer over Matthew's face (or by clicking the link below), one can hear a blood-curdling scream followed by the words 'for God's sake listen to Phelps'. I cannot help but wonder who provided the voice for this little audio extravaganza: perhaps a loyal parishioner; or perhaps one of the 52(!) unfortunate sprogs who get to call him Granddad

Well, you can always count on religion to foster understanding and toleration...

God Hates Fags...Apparently

I have spent most of the past few days alerting my friends to my latest internet find. Admittedly, it would seem that I'm a little behind on this discovery; all the same, I think it's worth the while mentioning since this little gem's existence seemed to be news to all my friends as well.

The site is called www.GodHatesFags.com and it is, extrodinarily, the official site of the Westboro Bapist Church. It's run by a minister of God called Fred Phelps, whose malign little mug can hopefully be seen above. Despite his butter-wouldn't-melt-in-my-mouth smile and faintly comical ten-gallon hat, Fred is, alas, a man filled with an unquenchable hate. There are many things that Fred hates: the marines, the Left, the press and, bizarrely, Sweden, to name but a few. But the thing most abhorrent to little ol' Fred and his darling parisheners - the common theme in their myriad dislikes - is homosexuality. Those pesky, God-forsaken fags have got Fred and his ilk all hot and bothered. Like the filthy, disease-ridden sodomites they are, the fags have spread across the world like a plague, infiltrating deep into its vital systems. That they are filthy and disease ridden will surprise nobody that has read Fred's carefully verified fact file on fag life. Here one can find such gems as '10% of fags eat shit and/or drink contaminated enema water' and 'the median age of death of fags is 42'. (Hmmm, you learn something new every day.) That they have infiltrated deep into the vital systems of Society will come as no great surprise to those who have recently been on one of Fred's little pickets against fags and 'fag-enablers'. Fred is none to pleased with the authorities who have, in the past, intervened to move him and his fellow haters on. Unfortunately the authorities don't seem to have reckoned with Fred's big, bearded friend in the sky, who, Fred rejoices, has smote the Marines down by the thousands in Iraq and unleashed great hurricaines to chastise the idolent Americains for not punishing fags with death. (Well, fair's fair, eh?)

Sadly, I fear, for Phelps at least, this sinner is far from venial.

Death to Father Christmas!

Today was far too stressful at work. Far too many moaning patients turned up on the ward claiming to be at death's door. Admittedly, most of them are pretty much there but, quite frankly, I don't see why oncology patients can't do their dying swan act in A&E like everybody else. As if I don't have enough to do without some captious old crone banging on about her terrible cough in between drags off her Silk Cut and declaring that she couldn't possibly go to A&E because she might have to wait! 'Well, we couldn't have that now, could we, love? I'll just miss my lunch break again and stay late while I do somebody else's job on top of my own for no recognition at all, but as long as you don't have to wait, eh?...' Grrrr.

This was made at the worse by Evil Father Christmas - my ancient, bearded old fart of a consultant - taking up his unending descant again about the need to wear a tie and the appalling lack of professionalism in modern doctors. This from a man who positively quivered with rage when I had the temerity to ask why I wasn't allowed to get palliative care involved in a patient's care without his express consent. Feet were stamped as he struggled to calm himself suffisciently to articulate his outrage: 'he was the director of this unit and he would not explain himself to me!' Stupid old fool! How professional is it I wonder to shack up with the married ward pharmacist of less-than-half his age? Oh yes, the hypocritical old goat wasn't the paragon of virtue and professionalism there now, was he?

I'm sure my mood wasn't helped by the fact I barely felt as if I had slept last night. It's all very well to have a somebody for sex, chats and kisses but once it's time to sleep having some other person in your bed is not conducive to a good night's rest. They make the bed too hot; they inevitably move and knock you just when you're about to nod off; even their breathing has the all the charm of dripping tap. My only hope it too wait until they are asleep and then try and get as far away from them as possible into the cool of a corner of the bed where I might finally be able to sleep. Plus, to top it all off, I have to get up at 7:20 whilst The Australian gets to spend a whole extra hour by himself in my bed before he has to get up. That's just not fair!

The Diary I Never Had

Fiat lux! Or, perhaps more aptly, fiat verba or something along those lines.

Inspired by my friends, I too have decided to give myself over to the frenzied mania of introspection. This blog - the modern equivalent of the not-so-well-hidden diary - shall be my medium. With this blog I shall do great things! Or maybe, like the gym, I'll pack it all in after a couple of idealistic and enthusiastic days.

I'm hiding in my office trying to avoid doing any work or seeing any of the patients. They're all proving to be a horrible drain on my psychological reserves today, which have been somewhat reduced by an over-indulgence of alcohol last night. Quite frankly, there's only so many ways and times you can say "you'll be lucky to see out the week" nicely. You'd think that when you're trapped in a bed, unable to walk, horribly swollen, with lungs full of fluid, bones full of cancer and kidneys shrunken to the size of walnuts, people would get the fact that the game is over. But no...relatives continue to cheerfully report that they think that John might finally be turning the corner. Why? Perhaps because he managed to ignore the terrible pain from his pressure sores for long enough drink three sips of water from a plastic beaker with the assistance of two nurses before slipping back into a drug-induced oblivion? Hmmmm. Not that we are any better: against overwhelming evidence to the contrary and in the face of obvious deterioration, the chemo just keeps on coming until the bitter end. "We must push on," goes the mantra, "it's their only chance." Chance of what? Quantity without quality is worthless.