Daylight Robbery

I sometimes wonder where all the money goes. Not all of my money personnally. I know where that goes: on booze and the good times. No, I mean all the money that the GMC and the Royal Colleges rake in in the form of fees for compulsory registration and examinations, respectively.

For example, the current cost of registration is some £290. For this paltry sum, one gets ones name added to the medical register. Wooohooo. Now, in 2004, there were 140,000 doctors in England alone. Based on that figure, that would be an annual income of roughly £40 million. Not a bad for keeping a list up to date, I'd say. If anybody can tell me what other useful function the GMC fulfills that might explain where some of that whopping wad of cash goes, I would be interested to hear.

The Royal College of Physcians on the other hand charges £295, £295 and £480 for the parts 1, 2 and 3 of its compulsory examination for membership. Should you be lucky enough to pass, it then charges you a further £200 for the privilege of a certificate. Most people spend an additional small fortune on courses and books to help them get through the exam, but I will ignore this as it does not go directly to the College. Thus, the absolute minimum you could spend to obtain your membership is £1270. Given that there were around 20,000 SHOs in England in 2004 - who will take on average 2 years to obtain membership - the College must, therefore, have an approximate annual income from its examinations of (1,270*20,000/2=) £25 million. And what does it provide in return for this? Absolutely sweet F.A.

I have an image of some College fat cat, Rolex on one hand and cigar in the other, waiving the latest cheque to pop through that esteemed institution's golden letter box, whilst he bellows out across the room to his rotund, red-faced chum: "so, Henry, still on for supper at the Ritz tonight? Looks like dinner's on...(squints through monocle to read cheque)...a certain Dr Sinner tonight. Charming!"

Aiding and Abetting

Most of the time I'm inclined to think that medicine is a good. Most of the time I believe that it helps. Most of the time I see it as an advanced and ever-advancing science that daily extends its kingdom of the rational into the benighted territories of the unknown.

Occasionally, however, I think it's just plain shit.

Last night was such a moment. I arrived in A&E to find only name on the list waiting to be seen, and it was a name I knew. Georgina Hall. I had first met Georgina all the way back in April, when I had been the admitting SHO for Neurofuckedology. She had been accepted as an emergency with a few days history of weakness in her arms and legs; that was all I knew. Georgina was a 23 years-old law student. Tall, slim and elegant, she lay in the bed looked scared. Her history and examination were worrying: a rapidly progressive spastic quadroparesis with respiratory involvement (translation: profound weakness and stiffness of all four limbs with difficultly breathing due to weakness of the muscle that allows us to breathe, the diaphragm). This suggested a problem at the top of the spinal cord or higher. The scans showed extensive inflammation and destruction at the level where the spinal cord and the brainstem meet. No cause was (or indeed ever has been) found.

Inflammation often responds to steroids and this case, thankfully, was no exception. Georgina regained strength in her legs and arms and by the time she was ready to go home she was walking, albeit unsteadily, and could just about manipulate largish objects with her hands. I left neurofuckedology thinking we had done some good.

Two months later I heard that Georgina was back. She had relapsed. The inflammation had spread to new areas in the lower, ancient part of the brain and she was only semi-conscious on the high dependency unit. The steroids were started again at super-high doses and again there was improvement, but it was slow. The tests had shown that the inflammation and damage had caused some epilepsy and so anti-epileptics were started. And that's the last I heard...until last night.

I must confess I was quite taken aback when I walked into the cubicle. In place of the slim, elegant young lady was a fat lump of a human being. The super-high doses of steroids had done their work mercilessly: they massively increase appetite and promote the storage of fat around the face and trunk. Yet there was still had significant weakness of her arms and legs, especially of the functionally vital hands. She had difficultly seeing clearly as the same inflammatory process that had damaged her spinal cord had also damaged the optic nerve, partially blinding her right eye. In addition, the anti-epileptic drugs she had been given to control the fits had completely wiped out her infection fighting cells. She was defenceless against the constant stream of marauding microbes around us. Her temperature had risen to 39.8 degrees centigrade and heart raced to maintain her falling blood pressure. Infection had taken hold.

O for the wonders of modern medicine! So much harm, so little benefit.

And it was such a struggle to get things moving. The rehabilitation unit she had come from had realised she had realised the grave situation that she was in - ill and defenceless - and had even written down in the notes what needed to be done. Georgina needed the domestos of antibiotics and she needed them immediately. But they had not been given. Instead they had been written as if to be given the next day, by which time Georgina could quite easily have been dead. That said, it was perhaps a small mercy that they had not been given since the dose of one of the most toxic of the antibiotics that had been written up was 3 times the maximum dose permissible and would probably have caused her kidneys to fail and the loss of her hearing. The nurses in A&E were painfully slow. I asked three times if they would put up the fluid I had written up to support her blood pressure before I realised I'd be better off doing it myself. They took an age to give one of the antibiotics and told me that they didn't keep the other in A&E. The seriousness of condition was clearly lost on them.

By the time I finally got her up to the ward I felt thoroughly depressed. The drugs had failed her. The people had failed her. Medicine had failed her. And in every stage I was complicit. Another cog in a clumsy and decrepit system that as often harms as it does help.

D'Oh!

When I was younger, I often did things that might be considered a little stupid - if not outright dangerous - just to 'see what happens'. I set fire to the kitchen bench trying to burn lighter fluid directly on the hob. I blew up the microwave because I liked watching the pink lightening created by cooking tin foil in there. (I told my parents it had exploded of its own accord, but I'm not really sure they bought this...especially when my Dad found the burnt bit of tin foil in the outside bin.) I even had an radio power cable that I had cut the end off and skinned the wires down to the copper so that I could connect whatever I pleased directly to the mains. I stuck two drawing pins into an orange, wired it up and turned it on. I wanted to see if it would fry. Nothing happened. I moved the drawing pins closer together and tried again. Again nothing. I moved them closer still until they were almost touching. I ficked the switch, the orange hissed, a huge blue flash lit up the room and a handful of bright, glowing dots seemed to almost to float in the air for a moment before drifting down lazily onto the carpet. I inspected the orange: a bit of it had indeed fried and burned much to my excitement, but where were the drawing pins? Turns out the drawing pins had also evaporated in the heat, giving rise to the blobs of molten tin that I had watched drift down and, alas I now realised, burn little black holes into the carpet. I realised my special cable had to go when I stuck the wires directly into a bowl of water and flung the switch: the water bubbled violently for a moment then everything went dark. I'd managed to fuse the house electrics.

And a leopard, it would seem, does not easily change its spots. Yesterday, I began to wonder why the dishwasher needed special tablets. Special, costly tablets. Why shouldn't it work just fine with Fairy Liquid? It is after all only a box that squirts hot water at things, is it not? What possibly could be the consequences of changing the cleaning fluid? At that moment, it was clear to me that the production, promotion and, indeed, prescription of a special cleaning product for dishwashers was nothing less than a keystone in the great, big capitalist lie that I had so far swallowed whole. It's goal: to enslave the proletariat by convincing them that they must work even harder for their capitalist masters so that they might be able to afford new, improved Finish Ultra 12-in-1 Powerball wonder tablets (and their like, naturally). In my moment of wild-eyed epiphony, I seized the Fairly Liquid and filled the little tablet tray to the brim. I would be a blind fool no longer: the time had come to cast off the shackles of the capitalist slavery! I set the machine going and retired to the living room to savour the moral superiority of my rebellion with a freshly brewed Bodum of Fairtrade coffee and a slice of organic, non-GM bread.

Approximately 30 minutes later, I was plunged into darkness and silence. No lights, no telly, no radio...no power. Wandering about my now tenebrose house, I sought the cause...and found it. The dishwasher was surrounded by a spreading pool of steamy water, whilst thick, bubbly foam oozed from the sides of the door in all directions. I've tried all sorts since: I've bailed it out, I've changed the fuses, I've even tried drying it out completely with a towel. Sadly, however, it remains resolutely and irredeemably dead. And each time you try and switch it on, it flicks the main trip-switch and cuts all the power. Alas, with the price of repairs as they are today, my Fairy Liquid experiment would appear to have turned out somewhat of a false economy. I haven't yet quite decided on the best way to tell my flatemate but I must confess that I'm leaning stongly towards the 'it just blew upon of its own accord' style of explanation.

Still, I suppose I did at least get to 'see what happens' when you break the rules.