Confessions of a Venial Sinner

Preparations

2006-12-11T19:54:00.000Z

Just two little days till I get on the flight to New York. Woohoo! Can't wait.

Anyway, on surveying my wardrobe, I realised that most of the rags dangling therein would not be out of place in one of those Victoria and Albert museum past fashions exhibitions. These were not the trendy threads that I imagined myself swanning about the Big Apple in. There was nothing to be done about it: I would simply have to go shopping!

And God do I hate shopping! I know, I know: I'm gay; I'm not supposed to be able to go more than two days without needing to spend £500 on the latest Dolce & Gabbana must-have, but it's just too stressful! You walk through the shop door and within seconds the first of the 'ever-so-helpful' shop assistants sweep down upon you to ask if you need any help. With what precisely might I need help? Looking at things? I can manage that just fine, thanks! Finding things I like? How the fuck are they going to know what I like! I end up being chased round the store by these intrusive busybodies until I eventually can't take any more and am harried out of the door.

If I actually manage to find anything I like I have to go through the torture out trying it on. That's if anything vaguely approximating my size is on the rack, rather than the XXL tents or XXS corsets that only ever seem to be left by the time I get there. Skulking into the funfair hall of mirrors that is the changing room, you find it has been lit in the most unflattering manner possible so that even if you were wearing a bespoke £10,000 garment by Versace (rather than the badly-made £10 Topman T-shirt you actually have in your hand), you'd still look like a sack of shit. You look around nervously, hoping that no stray Japanese whaling ships might be passing through and try to harpoon you by mistake. And I'm sure the only point of the person at the entrance to the changing room is to make you feel even worse when you have to hand them back because they don't fit. You can almost hear them whisper under their breath, "Well, did you really think you were going to fit into that, fatso?!"

Anyway, despite it all, I did actually manage to pick up a few new threads though, as soon as I got back from the shops, I had to run to the gym and it's only now two days later that I've actually been able to bring myself eat.

OK, so maybe I am a little gay after all...

No Rest For The Wicked

2006-12-05T20:35:00.000Z

Yesterday it occurred to me that it had been a fair while since I had bothered to exercise my typing fingers and add anything new to this pointless blog of mine. So, seeing as I am currently incarcerated in Hell's Hospital for the night, looking after the Gomers and Gomeres of Lower Londinivm, I thought I might spare a few minutes to clog up the internet a bit more with some random scribblings.

As evidenced by the previous posts, I had recently been wading through the quagmire of tedium and misery that is the membership exam for the Royal College of Physicians. The exam is a bitch and my preparation was, alas, not as thorough as it might have been. I had not expected to pass. And yet it seems I have; or at least that's what MRCPUK.org's internet result page says. Still, despite having rechecked most days since it was first published on Monday of last week, I cannot shake off the idea that when the paper results slip finally arrives in the post, I will find out that there has been some sort of terrible mix-up in the uploading of the computer results and I have, in fact, failed miserably. Though the rational part of me thinks this unlikely, the more significant irrational part of my personality has printed out the computer results page as evidence for when I am forced to sue the bastards for the emotional distress of having to tell everybody that it was all just a big balls-up and I actually failed.

Nonetheless, all that doubt and anxiety over whether I can yet put the letters MRCP after my name cannot really dampen the excitement generated by my approaching holidays. One whole month off work to do with as I please: to laze in bed; to drink on school nights; to fly far, far away. As it is, it looks to be a fairly busy one. After a week's R&R, I'm off to New York with my dearly beloved to see a city that I've always imagined as the only other place I'd live if not in London. Quite frankly, I can't wait till the plane takes off. Once back, I'll have a day or two before I climb aboard the train to Wonderland, whence the manger of my birth and bosom of my family await. Then I've made the courageous and extraordinary decision to abandon London for the New Year and hop on a plane over to the benighted backwater of Brittany to spend it with the Frenchman and his kin. Goodness knows what it'll be like, but after 9 years celebrating the New Year rat-arsed in some sweaty, dark hole of a club in the Big Smoke, I suppose it might be nice to do something a little different for a change. Finally, I head back to Paris for a slightly terrifying party where I am expected to meet and charm the entirety of my boyfriend's ridiculously large, French-speaking, French-being family: that's to say his parents (all four of them!), brothers, sisters, aunties, uncles, cousins, grandparents and assorted family friends! I have enquired as to whether it might not be possible to opt instead for the considerably less scary-sounding, mediaeval 'trial by fire' to assess if I'm good enough boyfriend material for their darling son, but have been told that, sadly, that is not an option. Thankfully, though, it is at least a party so I can just get horrendously drunk, which, as we all know, is always guaranteed to bring out the best in anybody.

At least one thing is certain: I will undoubtedly be more in need of a holiday by the end of this holiday than I was before I even started it.

100 Things Not To Do Before You Die

2006-10-24T21:51:00.000+01:00

I have just booked a room-with-a-view (of the nearby bustling motorway) in one of England's many suicidal, peri-metropolitan commuter towns. There, in the dark, dreary and deafeningly silent confines of my loney lodgings, I shall count down the seconds of Friday night until the appointed time of 'the Great Exam'. My only companion through those long, painful hours - 'till at long last the Saturday sun burns up the hazy gloom of an autumnal morning and I make my way to the crumbling District General - will be this ever-present, expanding sense of dread that gnaws at my entrails like a pack of hungry rats. Well, that and a litre bottle of cheap gin.

Wish me luck.

The Mother of all Exams

2006-10-07T02:24:00.000+01:00

De profundis clamavi ad te Domine!

Yes, well, if it's good enough for Oscar Wilde, then it's good enough for me too. Admittedly I might not be locked up in Reading Gaol doing hard labour for eyeing up some street urchin on the Tottenham Court Road, but I am nonetheless in the most uneviable of predicaments.

I am revising for PACES.

PACES is the third and final part of the post-graduate medical examination that all (British) physcians must pass in order to progress from a senior house officer to a registrar and beyond. Its name may well be an acronym derived from the rather benign-sounding Practical Assessment of Clinical Examination Skills, but the creature itself is anything but harmless.

Essentially it involves a serious of stations in which is perched some hideous, freak-of-nature patient with their nauseating pathologies shamelessly on show for all the world to see. You enter and examine the patient against the clock with the aim of correctly identifying what is wrong with them. Unfortunately, the whole proceeding is watched over with a hawk-like keeness by some decrepid old mummy of a consultant who has been specially dug up for the occaision. Should your examination not conform to their own idiosyncratic expectations, then beware: theirs is the power to pass or fail as the whim pleases. But not before the grilling, naturally. You present; they pounce: "so, aortic regurgitation, you think? And what, pray tell, are the 14 eponymous signs of severe aortic regurgitation? And what vanishingly-rare association of no clinical significance is there between aortic regurgitation and rectal bleeding?" Er. Er...

Best of all you get to pay £480 for the priviledge of sitting it. And that's not even to mention the vast sums of blutgeld demanded by those parasitic vultures who organise the revision courses or produce those obligatory books, without which can result only failure (or so we are told). At anywhere between $500 to £1500 a course and £30 to £70 a book, pearls of wisdom, it would seem, do not come cheap these days. In fact, PACES is a veritable gold-mine for everybody but the people sitting the bastard.

There are presently 21 days left until the my own big day. It's so comforting to know that I am just beginning a week of nights: I'm sure that'll help the revision no end!

Daylight Robbery

2006-09-15T18:47:00.000+01:00

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

2006-09-07T18:26:00.000+01:00

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!

2006-09-04T13:56:00.000+01:00

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.

Of Another World

2006-08-10T11:37:00.000+01:00

Often things do not turn out quite as people expected. Beautiful, fragile hopes are driven ashore by the vagaries of unpredictable circumstance and dashed to pieces on the hard, ugly rocks of reality. As humans, experience will have inured many of us to such disappointments. They are the stick that beats many a dreamer into submission. They are the shackles that bind people's feet firmly to the ground.

But Fate is a clever girl and she knows well enough that, if we are to keep on playing in this big game of chance that is life, then disappointment cannot be our only reward. And so sometimes our tentative expectations are fulfilled: no unforeseen horror awaits us just around the corner. We break even. And then, just occasionally, Fate, with her wicked, smile throws you all the aces and our dreams turn out to be but a pale shadow of another, more luminous reality, of another, more wonderful world, that could not be foreseen. And that, my dears, is the pay-out - the high - that keeps us hooked.

It is also, co-incidentally, the reason why I have not written anything on here for so long a time. Not so long back I made a decision to unyoke myself from all my emotional commitments on the basis of a growing desire to 'be free once again'. And so I did, but with the expectation that I would be not go willingly back into another relationship any time soon. Weeks passed, boys came and went (quite literally) and I felt more strongly than ever that the right decision had been made: I was not the type to tolerate another’s demands on my time well.

Then one night Fate thought to shake my cosy little assumptions up a bit. The Pink Psychiatrist and I were drinking (aren't we always?) in the local meat market, eyeing up the cattle for anything worth the effort of a bite, when along came a little surprise with spiky black hair and a sexy smile. We'd been watching each other for a while by the time he finally sidled up beside me with his pint and a nervous hello. It was all I needed to let go of my own inhibitions and after a little small talk we got down to the serious business of kissing. Intermittently we came up for air and to establish the facts: he was French, in marketing and spoke with an American accent because he had learnt his English in the Deep South. That was enough for the first night. Something inside me whispered 'you like this one a lot', and I wondered whether I was right in thinking it merely the Kronenbourg working its usual magic on the senses. We didn't sleep together that night - a quite astonishing fact to anybody who is gay – though, to be fair, most probably merely because his sister from France was out with him that night, rather than because of any propriety on our part! Instead, we parted at the bus stop with an agreement to meet for a spot of lunch the next day. The next day when I awoke I did so with a smile.

Almost eight weeks have passed since our 'spot of lunch' and the subsequent trip to the park that day, but they have been some of the most surprising I have experienced for very long time. For somebody who, in the past, has prized his independence more highly than anything else, they have also been some of the most disconcerting – even scary – weeks of my life: I have watched as those previously insurmountable barriers simply fall away without any effort or resistance on my part. What once I guarded jealously, I now give away freely.

Sickening stuff, isn’t it? Believe me, I know… but whilst this may not be my most literally accomplished post, it is almost certainly, and quite incredibly, one of my most honest.

Gay Ray's

2006-06-23T15:27:00.000+01:00

Even before it had begun, it had seemed obvious enough to the Pink Psychiatrist and I that this must be a night given over entirely to ephemeral pleasures of intoxication. It must be a night of debauched ribaldry; one suffused and animated by a spirit of riotous decadence. Some nights will tolerate nothing else.

The uncomfortable tension that had weighed heavy on the flat as we washed, dressed and sweated in the stifling heat of London's sudden summer found its relief in the cans of Tenent's Super Strength that we had bought for the walk into town. The tramps eyed us suspiciously as we passed with their ambrosia in hand, winding our away across the bridge and up the Charing Cross road, to the gates of the Citadel. We met the Frog and the Hanuman as planned and were, all four of us, carried like so much detritus in the streams of Lethe through the baking bars and streets of Soho; pushed and pulled on a tide of Leffe down through the gutters and the drinking dens of Wardour street; and washed up with starry-eyed wonder at the archway of Heaven itself.

The Frog helped us find Adam and Adam - as ever - brought Clarity to the proceedings. The lights were bright and the music intense. Hanuman swayed heavily under the burden of his too-powerful perspicacity. Speeding rhythms rattled around the room and The Pink Psychiatrist, that pryer into minds of madmen, wondered and wandered internally about the reason in their ravings. I kissed the Frog for perhaps an eternity, perhaps a second amidst the roaring torrents of coloured light that whirled all about us. Time flew and in it we all did too; until time was all used up and an end had come.

We harried and egged ourselves on into a taxi that sailed through streets lit by a hundred halogen suns with their cold and spindly light, until at length it drew up by a towering house and left us there in the cold of the night. Adam, exhausted, had taken leave of us and Hanuman marked his passing by becoming a little less Parky and a lot more sarky.

The door swung open and the Queen drifted into the hole it had left. With his plucked eyebrows, mascara and sparse, wispy hair, I had always thought the Queen looked much like a cancer patient in the early stages of chemotherapy. I saw no reason to revise that opinion tonight. 'Oh hello,' he said with some surprise, as if it had been a shock to find that a knock at the door actually meant there were people behind it. He was evidently 'proper chemist' (as the vulgar beauty of Northern tongue would have it). 'You got any drugs?' he continued at length; 'Nah,' we replied, pushing past him and, languidly, he gave way.

The other guests were scattered sparingly about the house and in the back garden. Something ambient and unobtrusive drifted out of the stereo and trickled down through the open patio doors out into the garden below. Hanuman found his bubbly consort, Lord Shani, draped over a beanbag in the lounge, from which he eventually rose with some difficulty to greet us. 'Have you met Gay Ray?' he drawled, waving a limp hand slowly to the left of him, 'it's his thing.' The Frog and I turned to pay our honours to the old soak who was already in the process of offering a Kit Kat to the Pink Psychiatrist in return for a kiss. The old man's dry and eager lips were not disappointed and the Pink Psychiatrist came up with a bump. 'Drinks!' exclaimed Gay Ray, reanimated by the success of his proposal, and set about pouring from the bottles arrayed on the side. Into one tumbler went a 50/50 mix of gin and vodka; another two received only vodka as the first creation had exhausted the last of the gin. He regretted insincerely the lack of mixers while clearly distributing his handiwork so as to try and ensure that his previous kiss might not be his last.

I ushered the Frog out into the cool of the garden, leaving the Pink Psychiatrist to the more healthy pursuit of some young ingénu who lay semi-collapsed on the couch. From the darkness, a haughty and agèd poof with a malevolent stare appeared suddenly. I retracted instinctively under the force of his regard, wrapping myself defensively in the warmth of the Frog's sinewy torso. He was a 'consultant' psychologist - a fact which did not surprise, but did much to explain the origins of the axe he appeared to be intent on grinding. His inquisition, interspersed with sniping attacks on the medical establishment (which, I presume, he hoped somewhat naively to be something I might take personally), seemed to last an age but was finally terminated when some kindly HIV consultant from my own hospital identified himself as a more reactive target by interjecting against some inviolable point that the 'consultant' psychologist was busy making. The Frog and I saw our chance and stole away into the night.

Hanuman bounced around in his new found enthusiasm for the great Beyond, something which, it seemed to me, would be more likely a hell than the Heaven we had just left. Not for me; not tonight. I waved my congratulations to the Pink Psychiatrist who, having made a welcome of initial indifference, was now intertwined with the ragdoll on the couch. My fingers found the small of the Frog's back and guided him gently, through the door, down the steps, and all the way home, hand in hand, through the silent streets of a sleeping city.

Redivivus

2006-06-15T02:27:00.000+01:00

Ha! I bet you thought I was dead, didn't you, you bastards? That the last of me might have eeked itself out in a some stale lamentation dedicated to a plastic pop princess? How fitting, you smirked. Thighs were smacked. Coffins, I imagine, were danced upon.

O but too early ye celebrations!

Born again (but far from Christianised), The Venial Sinner est de retour... et plus vif que jamais.

His life has known some changes recently. He is single again, but regrets nothing. He is no longer a neurologist, but hopes to be so in the future. He has moved, but remains, essentially, in the same place. He has plans, yet desires no real change.

He says:

It's nice to be back.

Rouge Colère, Sombre Douleur

2006-05-14T15:54:00.000+01:00

What hope for he who has subjugated himself to his selfishness and fashioned gods of his whims and caprices? What hope for he who has built himself a buttressed fortress of excessive intellectualisation in which to hide from the swarming armies of emotion outside? What hope for he who, believing himself ever starved in an unrelenting famine of time, searches frantically for more, more, and more?

What hope for he?

Some, I pray.

Life and Death

2006-05-08T17:36:00.000+01:00

O what a glorious day! O what a wonderous day! Why? Well, because it's my birthday. Another year in the technicolour, cavalcade of fun and frolics has passed and I am still alive...

...which is more than can be said for 14 year-old Ahmed Khalil who was shot in Iraq at point-blank range by men in police uniforms for the crime of being a homosexual. According to the Independent today, it would seem that young Ahmed may have slept with men for money to support his poverty-stricken family, who have now fled the area fearing further reprisals. The country has seen a spurt of homophobic murders since Grand Ayatollah Ali al-Sistani issued a 'fatwa' against homosexuals calling for them to be killed in the worst possible way. The good Ayatollah has been held up in the past as the saviour of a post-war, democratised Iraq by many western sources, including over-inflated, homo journalist Johann Hari (who, coincidentally, writes for the Independent). I wonder whether this will be enough to change their minds? Certainly there has been no condamnation forthcoming from the US or UK administrations - they need al-Sistani too much for that.

I have written about al-Sistani and his fatwa in a previous post. Nobody commented. Perhaps nobody cares? After all, what's a few dead gays between friends?

A Little Light Relief

2006-05-06T18:58:00.000+01:00

I once asked a boozy lezza to summarise a gay female's approach to love. She paused, gave a knowing smile, then spoke:

'What does a lesbian bring with her on a second date?'
'I don't know,' I replied
'A suitcase.'

I laughed, then asked her:

'And what does a gay man bring on his second date?'
'I don't know,' she replied
'Somebody else.'

*********************************************

I found this on another blogger's site and she has kindly allowed me to steal it.

I think you'll agree that it's simply hilarious. Poor Jimmy Barnes - entrapped by a man in dodgey sunglasses with a silent sickness as deadly and contagious as smallpox.

It just goes to show: one never knows when the homosexual is about.homosexual humour.gay humour

God Moves In Mysterious Ways...

2006-05-02T04:47:00.000+01:00

...but then again so does Miss Rogers. Ah, I remember the day that the I first had the pleasure of the one and only, the unforgettable Miss Divina Rogers. I had been forewarned, of course: we doctors don't like to shit on a colleague’s doorstep without at least saying sorry. The registrar responsible for her admission had sidled up to me on the ward and confessed all. "There's one coming in today that I saw in clinic," she said hesitatingly, "who..erm...might be a bit of a challenge. Sorry." I knew the code well: for 'challenge' read 'barking mad'. When finally she made her debut entrance into the ward, she left no-one in any doubt as to the veracity of the registrar's warning.

The first thing I noticed was the fact that she appeared to be moving almost every muscle in her body simultaneously but in different directions. This lent her the air of somebody plugged into the mains, an image further strengthened by the fact she was indeed in an electric (wheel)chair. She was also wearing the most comical facial expression I have ever seen, something akin to a very shocked Cyril 'Blakey' Blake from On The Buses. Her voice can only be described as extraordinary. It's volume and tone veered up and down in such a fascinating way as to make it hard to concentrate on what she was actually saying. "Lordy," I thought to myself, "the circus has come to town."

The examination was nigh on impossible. Any attempt to get her to do anything only succeeded in exaggerating the movements until they attained a violence which would have been quite frightening, were it not so funny. The past medical history was sadly predictable: a paracetamol overdose, fybromyalgia and heavy investigation for unexplained abdominal symptoms. We did our duty all the same. She had the works: a page's worth of blood tests, an MRI, a lumbar puncture and an EEG. And surprise, surprise: there were all plum normal.

Now believe it or not, I tell you the story of Davina Rogers not as a joke (even if I do poke fun at it), but as an example of what constitutes a not insignificant proportion of any medical specialities workload - medically unexplained symptoms (MUS). The chest docs have 'atypical chest pain', the gastros have 'irritable bowel', the ENT docs get 'globus hystericus' and we, more commonly than the florid presentation above, see the 'pseudoseizures'. Yet, regardless of their differing labels, they all have at least one thing in common: there are symptoms for which no organic basis can be identified. The tests have been done - the colonoscopies, the ECG, the angiograms, the xrays, the EEGs, the CTs and whatever else might reasonably be tried - but they have all come back plumb normal. And it's there that the real problems start.

The first problem concerns what exactly to do with these patients once you have reached this stage. In many ways, doctors are like detectives: a patient presents with a certain symptom and the doctor works towards solving the mystery of the underlying causative pathology. When this mystery fails to yield an answer, however, the doctor is likely to become fatigued, dejected and might well lose interest in the case. The temptation is thus to discharge the patient from follow-up with the label of 'medically fit' and have done with them once and for all. Yet this approach fails to acknowledge that 'medically fit' people might still be in need of help, even if they have come to the wrong person in search of it. Indeed, in the case of medically unexplained symptoms, there is good evidence that if the diagnosis is made early enough and, if necessary, the patient manoeuvred towards the psychiatrists, the prognosis is good. The longer they are left to ping-pong around within the medical referral system, the less the chance of ridding them of their symptoms.

The most common misconception is that these patients are malingerers. This is incorrect from both a psychiatric and, indeed, a common-sense point of view. Malingering, by definition, aims to obtain a tangible benefit for the malingerer: the classic example being the heroin addict who feigns abdominal pain to obtain morphine. But in the case of MUS, the patient accrues no obvious benefit from their contact with medical specialists. They may even suffer harm in the form of side-effects of empirical treatments or complications of unnecessary investigations and procedures. The essence of MUS is illness behaviour in the absence of any identifiable organic disease. The absence of identifiable organic disease, however, in no way implies the suffering of patients with MUS is any less real. Unlike the malingerer who gets up and walks away once his goal is achieved or his scheming uncovered, patient with MUS are often persistently disabled, either physically or socially, by their symptoms in a way which dramatically reduces their quality of life. In the case of Miss Rogers above, she was wheelchair-bound despite the fact that no neurological need for one could be found.

One of the most difficult things is deciding how best to explain a set of normal investigations to a patient who continues to exhibit symptoms. To my mind, there are two ways of looking at it. Either, the tests are not good enough to pick up the underlying pathology; or, alternatively, there is no underlying pathology. Striking the right balance between these two ideas can be tricky though. Too much of the former and the patient goes away thinking that there must be an organic cause for their problems but it's just too complicated for us to work out yet; too much of the latter and they only hear "you're making it all up". Neither impression is likely to be helpful. You need to get the patient on your side if you are to stand any chance of having a positive impact on their life. You must help the patient come to terms with the fact the there are no more investigations to be done, whilst emphasizing that this is not equivalent to saying that we have nothing to offer in the way of help. It is essential, I think, that you frame the idea of a non-organic cause for their symptoms in such a way that allows the patient to accept this psychological framework with dignity and without loss of face. In addition, the stigma surrounding mental health issues is, alas, still powerful and efforts must be made to mitigate against this if the patient is not to understand a psychological explanation of their symptoms as an accusation of madness. With this kind of approach I usually find that patients' initial resistance to psychological interventions soon gives way to a willingness to try.

It currently falls to the psychiatrists to deal with those cases of MUS that are actually recognised as such and not just left to bounce backwards and forwards from one physician to another. We have an excellent service here at my hallowed institution, but I imagine other centres might not be so lucky. There is evidence for benefit from a whole range of treatments in MUS, from physiotherapy, through psychotropic medication (particularly SSRIs as depression often underlies MUS), all the way up to CBT and other forms of psychotherapy.

As ever in the NHS, the clinch comes in the difficulties of balancing demand and supply. The scale of the problem is mammoth. Between 5-15% of all GPs' workload is estimated to consist of MUS. Yet psychiatry is underfunded and the parapsychiatric specialities even more so. Clearly a system that is already failing to deal with the tip is never going to cope with the whole of the iceberg. The solution, of course, lies in investment and a recognition that a significant amount of money could be saved in terms of benefits, repeated appointments, and needless investigations, if MUS was recognised as such early on and treated accordingly. Somehow I doubt that will be a recognition that's made within our lifetime...functional illness MUS medically unexplained symptoms

Reality (vs) TV

2006-04-28T06:46:00.000+01:00

Pretty much every doctor in England likes nothing better than a good piss-ripping session about the medical dramas that proliferate daily to fill our TV schedules. Whether it be the upside down x-ray, the incorrect management plan or the fact that the fresh-from-med-school house officer has just been left to perform open heart surgery on some old dear while the consultant nips out to the bogs to self-medicate with another hit of stolen pethidine, it does sometimes all conspire to make you think that no amount of medical advisors will ever stop them getting it all so horribly wrong.

To my own mind, however, the truly amusing thing about the medical soaps is how wonderfully glamorous they make medicine seem. If it’s not the fact that everybody is hotter than a page 3 hotty, then perhaps it's the fact that they seem to pass their whole day making end-of-the-bed, life-saving spot diagnoses or cutting people back to health without breaking a sweat and all in time to grab that quick beer after work with the fit patient whose entire previously-insoluble life problems they sorted out earlier with a few well-chosen words!

But O the reality of it! And O how it bites tonight!

‘Venflon needs doing for bed 5 and 26 and there’s a drug chart needs rewriting for bed 15’ was the greeting I received when I stepped onto the ward tonight. Not even a ‘how-are-you?’ or ‘sleep-well?’; just straight down to the nitty gritty of it. I answered my bleep a little later to have ‘dhere’s pus needs took to the lab from t'eatres’ barked into my ear by Ms McFeisty, the leprechaun of neurosurgical registrar on call with me tonight. There’s something in Ms McFeisty’s manner that tells you she didn’t get to where she is today by battering her eyelids and smiling coyly; no, I see scalps taken and the scrotums of enemies crushed beneath a stiletto heel. Think less Goldilocks and more Martin McGuinness with tits. (Oh, I'm sorry: I temporarily forgot that Mr McGuinness is now a noble statesman committed to the peaceful release of his country from the shackles of its colonial oppressors, and not in fact a murderous terrorist in a balaclava who'd have your kneecaps off at the drop of a hat.) Anyway, I entered theatres to find the McFeisty energetically sucking the pus from a young man’s brain whilst simultaneously berating the scrub nurse for not handing her the gauze fast enough. Without looking up she quickly spat out ‘19. IVDU. Cerebral abscess. On cef and rifampicin. Urgent Gramm stain. Results to ITU’. I waited a moment until I was sure the staccato list of instructions was over before I picked up the sample and left. So this is it – the culmination of six years and tens of thousands of pounds worth of education: ferrying pus around the hospital in the dead of night. Isn’t it just faaaabulous, daaarling!

Oneiromancy

2006-04-26T14:04:00.000+01:00

Sleep has all but deserted me these days and even when it comes it is spasmodic and punctuated by nightmares.

The masochistic element of my mind has once again taken to its duties as my own personal torturer with a zeal. Chief among the tools of its trade is sleep paralysis. After a break of several months, these terrifying episodes have slowly crept back in to torment me.

It is as if, suddenly and without any warning, a part of my conscious mind breaks the surface of the murky waters that have so far shrouded it in sleep and is again aware. Aware of the position of my body; of the feel of the sheets against my skin; of the give of the mattress beneath me. Aware, in sum, of all the things that you might know if you were lying on your bed awake but with your eyes closed. Yet still, the rest of my mind sleeps on and I cannot move. I slowly mounting feeling of panic rises in whatever part of me is aware as it, and I, struggle to move a body that feels like it is floating in treacle. I cannot move. I feel my heart beating faster and harder in a chest constricted by the grip of fear. I cannot move. And yet I must move; for there is someone or something in the room. I do not know what this thing is – I cannot see it – but I feel its approach all the same. The mattress bends and gives under the weight of its body as it crawls up onto the bed. I strain to cry out: no sound but perhaps muted and pathetic whimper escapes my throat. I struggle to pull myself up from the bed: still I cannot break free from the viscous air that smothers me. The terror becomes overwhelming as the thing’s progress towards me is mapped out in the shifting imprints of its weight on the mattress. It is so close now. Almost over me. Bearing down. My heart feels like it might burst, my limbs tense with mental effort, and my throat tightens with the scream I cannot emit. Suddenly there is give: the treacle evaporates, the constricting bands of fear around my chest break, my body lurches up, my eyes spring open…I am awake and only the pounding of my heart remains.

This may happen several times in one night. Sometimes there are voices too: children laughing or just the insistent sound of my name repeated slowly again and again. I do not know why they happen and I cannot stop them.

Last night I dreamt I was in a tin bath full of the putrid and filthy water. From the bath I can see into two other rooms. In one, I see my family sitting on a white sofa facing away from me. Around them, like a court jester, cart-wheeling and dancing, is the Australian with all his hair shaved off. The more I stare at him the more he seems to be two people at once. The Australian and my first ever boyfriend rolled up in one. I can feel the happiness they radiate and hear their riotous laughter echoing about. After a little while I turn to the other room where enormous, snorting, wild-eyed horses rear up at each other as if in the throes of brain fever. These are truly gargantuan beasts and watching them thrash and crash about the room fills me with fear. I decide to get out of the bath. I pull the plug and the water drains away slowly to reveal that I have been sharing my bath with a joint of raw meat. I sit naked and stare at it impassively. The dream ends.

I mean what on Earth is that all about? Any budding Freuds want to give it a go?

Money Makes The World Go Round

2006-04-18T19:25:00.000+01:00

I haven't written for a while. There have been too many other competing interests for my energies of late.

A rather substantial portion has been devoted to work. I am not one to rally under the flag of medicine-as-a-vocation. Nor would I wish to sarifice my own life on alter of altruism. Nonetheless, I do take pride in doing a good job by the people I look after. As a system the NHS is inherently inefficient and I find that, in order to get a recent result out, you have to put a disproportionate amount of energy in. At times this can be truely exhausting.

Still, whatever its failings, the NHS cannot be said to be as inefficient as my boiler. It is effectively nothing more than one big, unclad kettle, sitting in a cupboard at the back of the flat. When it's on, it is scarcely possible to open the cupboard door without risking third-degree burns from the incredible heat that radiates from its thin metal body. I have come to suspect that this beast-in-the-backroom has single-handedly run up most of the energy for which London Electric are currently demanding blood money to the tune of a ludicrous £900.

In addition, several other companies and organisations' claims on my money have become so persistent (and menacing) as of late that I have been forced to remove my head from the sand and review the situation. The situation, alas, is bleak. £1000 council tax unpaid. £400 of arrears in my student loans. Tiresome, irksome affairs of which various voices on the other end of the phone speak to me in comically serious tones. They seem to find it beyound belief that I have no records of account numbers or am unable to give precise details for a direct debit on my account; personally, I find it beyond belief that anybody could to be bothered to waste time memorising such banal trivia. My dealings have led to the conclusion that I'm not one for the crass business of finance. I earn it and I spend it - that is the limit of my interest in money.

Thankfully, I can escape all these mundane concerns in the clubs of London. So long as I have the money in my pocket to buy the next round, who care's about bills and deadly serious debt collectors. Let them wait - I'll pay...eventually.

Lolita And The Elusive I

2006-04-06T20:40:00.000+01:00

I am being sexually harassed by one of the patient's on my ward. Bad, eh? Want to know what's worse - she's only 16 years old!

It's a bit sad really. According to her family, just a few months ago Lolita was a happy, normal 16 year old girl. One day she complained she felt a bit unwell. She stayed at home and slept for 48 hours. When she awoke her personality had been altered completely. Gone was any trace of inhibition; in its place a mind focused only on the pursuit of 'fit men' and her newly found habit of smoking rollies.

It looks likely that Lolita may have had encephalitis - a infection of the brain tissue itself. Though it seems to have resolved spontaneously, it has left its mark on her brain. The damage it has caused is too subtle to see on even the most detailed scans, but we can pick it up as changes in the electrical noise from parts of her brain. This damage has also left its mark on Lolita's personality: she no longer has any appreciation of what is socially appropriate.

She has taken a bit of a shine to me and has decided that we are to get married. She sees nothing wrong with walking in while I am speaking to another patient, introducing herself and explaining that I am her husband to be and that the honeymoon will be in Spain. "Only joking", she winks at me coquettishly as I usher her out of the room. Once I've gone, Lolita is always the first to meet and greet the new patients.

Mainly she wants to know about their love life: are they single? do they have a fit boyfriend? are they gay? do they wanna go for a smoke? To the uninitiated this barrage can be a little bewildering; to the experienced, a lot annoying.

The real problem, of course, lies in what will happen when she is outside of the safety of the ward. Whereas I normally greet her screeches of "nice arse, doc!" with a roll of my eyes and flush of the cheeks (on my face, that is - you dirty bastards!), how will your typical sex-starved teenager react? How will they respond to her flirting? Will they stop if she changes her mind? I often see her as I arrive in the morning talking with random (male) passers-by as she smokes her rollies outside the hospital gates and she likes nothing better to go trawling the hospital in searh of 'fit men'. Alas, the only real threat that Lolita poses is to herself. With her new disinhibited, forward personality, there is a strong chance that she will quickly fall into sex and drugs and out of education.

So much for the soul as the seat of our essence. Everything that we are resides solely in the organic structure of our brain and nowhere else. An organ more complicated than anything we have ever dreamt of. Some 100 billion neurones forming an estimated 500 trillion connections with each other, suspended in a web of around 1 trillion glia: these are the building blocks of the brain.

And "I" is the more that emerges from the sum of these parts.

When a kidney is removed or a liver damaged, "I" remains essentially unchanged. Yet, even with relatively mild damage to the brain, the meaning of "I" may be profoundly altered. For Lolita, whereas "I" once embodied a happy, stable child, it now describes an oversexed, irresponsible and socially-inept stranger. At times it is funny to watch, but mostly it's just terribly, terribly sad.

Braziliana

2006-04-02T13:40:00.000+01:00

If all goes to plan, I'll be off to Rio de Janeiro in June. Rio is one of those places that has always fascinated me. It has a reputation as one of the most disinhibited cities on Earth, jam-packed with effortlessly sexy party-people living lives of unending hedonistic delight. Ideally I'd have liked to go in February when the Brazilians’ bacchanalia reaches an orgiastic climax in the form of Carnival, but fixed annual leave does not allow for any choice on the timing of my trip.

After a brief inspection of my body in the bathroom mirror, I figured some work might well be needed in order to avoid the possibility of being harpooned on Ipanema beach when accidentally mistaken for a beached whale. Consequently, for the last week now, I have been following my Rio Hard-Body Regime. This consists essentially of the Atkins diet and three 45 minute cardio sessions at the gym. Yes, that’s right – the Atkins diet. I know it’s tragic but a gayboy’s gotta do what a gayboy’s gotta do to get into his Aussiebum swimming trunks. For the benefit of anybody who’s been off the planet for the last few years, the Atkins diet allows you to eat whatever you want so long as it’s protein or fat; no carbohydrate-based foodstuffs at all. That means no bread, no pasta, no rice, few vegetables, and no fruit. Yet, strangely enough it does work, though not, it seems, because of anything to do with ketosis or reduced insulin release – as its designer originally claimed – but because people eating high protein diets just eat less. Whether this is due to protein’s effect on satiety or just the unappetising nature of a pure protein diet is difficult to say. In any case, I plan to stay on it until I go to Rio so I’ll let you know if it actually produces the goods before I succumb to scurvy or rickets.

Last night I joined in the celebrations for The Greatest Dancer’s 27th birthday, which were held, appropriately, at Guanabara, a Brazilian-themed bar just off Drury lane. The tone for the evening was set when four of us went to the bar to buy a cocktail, realised it was happy hour and so bought twenty-eight of them! The highpoint of the evening, however, had to be the concoction colectively purchased by the group with the express intention of completely destroying the birthday boy: some hideous mix of cachaca, Baileys and the puke-inducing liqueur, midori. Having been part of the football team at med school, The Greatest Dancer has had considerable experience in downing disgusting concoctions, but there was a moment when I thought this one might prove to be a step too far. Just when he was insisting he could manage no more, two random physios – one quite pretty who we shall call Porsche and the other less so who we shall call Minivan – intervened to egg him on to the bitter end. I couldn’t help wondering whether Minivan, who had attempted to disguise her ugliness by caking her face in orangey make-up, might not have had an ulterior motive for her sudden concern that he drink up. Perhaps in that Belisha beacon of head of hers the realisation had dawned that only someone on the verge of an ethanolic coma would be likely to find her attractive enough to kiss. With this in mind, we escorted The Greatest Dancer back to the safety of the herd where he could deteriorate into a dribbling, giggling wreck in safety. I should imagine it’ll be a birthday that he’ll not remember for a very long time to come!

Modern Day Nursery Rhymes

2006-03-25T15:57:00.000Z

Number One - The NHS is Falling Down (music here)

The NHS is falling down,
Falling down, falling down.
The NHS is falling down,
My fair Patricia!

How shall we build it up again,
Up again, up again?
How shall we build it up again,
My fair Patricia!

Build it up with spin and lies,
Spin and lies, spin and lies.
Build it up with spin and lies,
My fair Patricia!

Spin and lies will wash away,
Wash away, wash away.
Spin and lies will wash away,
My fair Patricia!

Build it up with P. F. I.,
P. F. I., P. F. I..
Build it up with P. F. I.,
My fair Patricia!

P. F. I. will cost a bomb,
Cost a bomb, cost a bomb.
P. F. I. will cost a bomb,
My fair Patricia!

Build it up with management,
Management, management.
Build it up with management,
My fair Patricia!

Management will make it worse,
Make it worse, make it worse.
Management will make it worse,
My fair Patricia!

Build it up with silver and gold,
Silver and gold, silver and gold.
Build it up with silver and gold,
My fair Patricia

Silver and gold will be eaten up,
Eaten up, eaten up.
Silver and gold will be eaten up,
My fair Patricia

Sack the doctors - they won't fight,
They won't fight, they won't fight!
Sack the doctors - they won't fight,
My fair Patricia!

Suppose the patients might complain,
Might complain, might complain?
Suppose the patients might complain,
My fair Patricia!

Then blame everybody else in sight,
Else in sight, else in sight!
Blame the Torys and the Right,
Myyyy Faaaaaair Patriciaaaaaaaaaaaaaaaaaa!

By The Venial Sinner (original nursery rhyme here)

Mardy Bum

2006-03-21T22:18:00.000Z

I got out of the wrong side of the bed this morning. I looked in the mirror and thought: “Jeez, what the fuck happened there!?” After half an hour of trying to rearrange my face and my hair into a vaguely passable shape, I gave up and stumbled out of the door into the harsh winter light. I arrived at the end of the road just in time to watch both of the buses I needed to catch to work speed away from stop. As I waited in the perishing cold, it started to rain and I felt a silent hate for this particular day fill my gut.

I tried to comfort myself in the knowledge that only one lumbar puncture then a brief teaching session for the medical students stood between me and the return to my bed. I was none too impressed when the Health Care Assistant told me in her toneless, monosyballic pigeon that “patient not on ward. Gone x-ray”. In fact I knew she was to go to neurophysiology to have her evoked potentials checked but I’ve long since decided that further interrogating a HCA is much like asking the speaking clock the meaning of life: once they have passed on to you whatever nugget they’ve been programmed to say, any attempts to extract more information will only result in repetition. Still, I’d thought she’d be back from neurofizz by now. I decided to set up the trolley in expectation but only succeeded in demonstrating how highly strung I was to the rest of the ward by having a hissy fit over the lack of brown sterilization fluid. “No, the blue stuff will not do!”, I explained through gritted teeth, “I know it does the same thing but I always use the brown and I’m not changing now!”. In the end, the poor HCA had to be reprogrammed to fetch some from another ward. Then I waited…and waited……and waited!

By the time the patient arrived back at 12pm, I was seething inwardly with quiet rage. “No, you cannot have lunch, I’m afraid – I’m very busy and I can only do this now”, I lied. In retrospect I wonder if divine retribution might not really exist because it was at this point that everything just got worse. I tried to open the one of those ridiculous glass vials of local anaesthetic and nearly sliced the end of my index finger off when it decided to disintegrate in my hands. Having just warned her that the anaesthetic would sting a bit and not to move, I began to inject, at which point she immediately wriggled of the end of the needle in discomfort, sending a jet of lignocaine up her back. I felt my eyebrows ascend to such heights that they were in serious danger of leaving my face. When she repeated this trick later on, it had even more spectacular results: the barrel of the syringe came off the needle while I was pushing with all my might so that the lignocaine exploded all over my face and eyes. Needless to say I was none too impressed.

By the time I got back to the ward, still clutching the samples because – like everything else in my shithole of an institution – the label printer was on the blink, my medical students were already waiting for me. I remember the first time me and one of the other SHOs, The English Rose, had gone to meet our students. When I saw the geeks that I had been lumbered with and compared them to the rather tasty grouping that The English Rose had got, I suddenly had a bad case of student envy. Whereas I'd got an assortment of spotty nerds, she'd got the chiselled cool kids. It's much the same feeling as when you order at a restaurant and your friend’s choice arrives looking simply exquisite whilst yours looks like something the dog might quite reasonably turn its nose up at. I decided that the only way to make myself feel better about this day was to take it all out on my hapless students by ridiculing them mercilessly. Esoteric medical trivia that I had only learnt the other day I dressed up as common knowledge that even my ganny would know. And yes, I did feel better as I watched that blotchy, red rash of nervousness spread across their faces. "How can you not recognise a case of Wallenberg's syndrome when you see it? And how soon did you say the exams were again?" I greeted their answer with a long sucking noise through my teeth to indicate my lack of faith in their ability to make it. Cruel, I know, but in a dog eat dog world, you’ve gotta be out for number 1.

Maybe tomorrow I'll try the other side of the bed: I think, in the long run, it might be better for my karma.

Tempus Fugit (Et Nos Fugimus In Illus?)

2006-03-19T23:08:00.000Z

The realities thrusts in your face from time to time by life are not always palatable. Indeed, sometimes they have all the appeal of a steaming turd. For some time now I have been haunted by the recurrent thought that, in all probability, my life will be of absolutely no consequence whatsoever in the grand scheme of things.

I will live, I will love, I will work and I will die; but after that is all done and dusted, nothing will remain. There will be nothing that will endure; nothing that will survive me; no scar on the face of posterity that people might contemplate long after its creator has ceased to be. Nothing that is either of me, from me or because of me shall remain. Nothing.

This is the possibility that I most fear and, moreover, a possibility that, with each passing moment that I fail to do anything of any lasting consequence, becomes just that little bit more real. It is the burgeoning reality slowly shaped by the action of continuously passing time on the great hunk of hypothetical possibility that was my life at birth. When all the flimsy, sandstone frivolities of my existence have been washed away in the streams of history, what will remain? Could there be a hard core of strong and sturdy stuff somewhere with in me that might resist, that might persist, and that might even change the direction of the flow, if only by a fraction of a degree? Probably not, but surely it must be everybody’s dream.

I remember reading about Rousseau and the ideas that he set down in his Social Contract. Rousseau was already dead when his war cry against oppression gave birth to a mutant child – the French revolution. It was a revolution that tore through the status quo and irreparably altered our beliefs about power and its exercise. It will not be forgotten – for better or for worse – and nor will Rousseau. His big idea gave him a form of immortality; in reality, probably the only form that is really open to any human being.

As I flit from blog to blog – like a fly flitting from wall to wall – sampling each little world before moving on, I feel overawed by what I find. I see such a frenzy of creative energy everywhere. I see people crafting beautiful stories, left to float in cyberspace for others to chance upon by happy accident. Moments in peoples’ lives crystallized and annotated for others to explore. I see people sharing thoughts and observations on the world around them and, in so doing, asking important and incisive questions about why it should be ordered in this, and not some other, way. I see people striving to find a big idea, like Rousseau's, that will make things better and joining forces with others to help them find their way intellectually. It’s an amazing thing to be allowed to watch and, indeed, even participate in.

Nonetheless, I can’t help feeling a little depressed when I see how gracefully and concisely some other people are capable of expressing their thoughts. I read about a American soldier dealing with the reality of his loved-one leaving for war and being overwhelmed by the possibility that he may not return. I thought it was beautiful. And I knew I would not be capable of writing anything like it. I couldn’t help but wonder how long it would endure for as an idea in the ether of the internet, waiting for somebody else to find it. Could it outlast its author, hidden on some server somewhere, only resurface to affect some other, unsuspecting else? I honestly have no idea. OK, so it wasn’t an idea that was going to change the world or spawn a revolution, but what does that really matter in the end? As long as we leave some mark, any mark, then perhaps we have had our little victory over time, even if it will always win the war.

A Brave New World

2006-03-17T16:03:00.000Z

Thank the Lord that we English doctors had the time and resources to waste treating Grand Ayatollah Ali al-Sistani in August of 2004 when he was flown over to London for angioplasty at the governement's expense. The frail 74 year-old man who underwent a triple-bypass operation has been held up as the poster boy of a democratised, post-war Iraq not just by various real political commentators, but also by fat boy, homo journalist Johann Hari. Hari does at least point out that his new best friend "has views on social issues that, to a Western leftie, are (at best) distasteful. He is critical of divorce and he certainly isn't going to be joining any Gay Pride parades. But he believes in opening up a democratic space in which these ideas can be discussed."

No gay pride parades? Bit of an understatement some might say. On his own website, Al -sistani calls for the killing of homosexuals in "the worst, most severe way". For those, like myself, who can't read arabic, question 5 under 'lewat' (homosexual) asks "what is the judgement for sodomy and lesbianism?". The answer is clear: "Forbibben. Punished. In fact, killed. The people involved should be killed in the worst, most severe way of killing."

Exiled Iraqi Ali Hili, who heads up the LGBT UK Abu Nawas group is also unimpressed with Hari's taste in friends. He wants people to know about the Badr Corps and their activities in Iraq. He claims that "the Badr Corps is in fact nothing more than the military wing of Supreme Council for Islamic Revolution", which views Al-Sistani as its main spiritual leader. Badr has fronted a witch-hunt of lesbians and gays, using a network of informers who target immoral behaviour. "They kill gays, unveiled women, prostitutes, people who sell or drink alcohol, and those who listen to western music and wear western fashions. Badr militants are entrapping gay men via internet chat rooms. They arrange a date, and then beat and kill the victim."

Sounds fun, eh? Maybe not quite what you were expecting when you ordered out on Gaydar. Haydar Faiek, aged 40, a transsexual Iraqi, was beaten and burned to death by Badr militias in the main street in the Al-Karada district of Baghdad in September 2005. Sarmad and Khalid were partners who lived in the Al-Jameha area of Baghdad. Persons unknown revealed their same-sex relationship. They were abducted by the Badr organisation in April 2005. Their bodies were found two months later, in June, bound, blindfolded and shot in the back of the head

And they say that this is the best hope for Iraq?iraq homophobia gay al-sistani murder

Music To My Ears

2006-03-16T12:53:00.000Z

I'm having a fairly cultured week for once, it must be said. On Monday night I decided to dump my pre-planned evening in front of BBC4's Fantabulosa to join my friends in their trip to see the Shortwave Set play. I met Monobrow and Lady Muck at 7pm sharp in the backwater village of Shepherd's bush, which also conveniently doubles as the Australian National Homeland. They had both bought the album beforehand and, as newly converted disciples, immediately set to prosletysing for my conversion. I decided to reserve my judgement all the same. The support acts were varied: the first - called Cherry Ghost, I think - were a refreshingly uncool, Johnny-Cash-esque three-piece that I rather liked; the second, whose name failed to make an impression, contented themselves with pumping out some generic loud noise, which impressed nobody but themselves.

As for The Shortwave Set themselves, they were superb. I don't have a big enough musical vocabulary to be able to categorise them or their possible influences with any confidence, but then again perhaps that's for the best as the real clincher for me was their originality and their willingness to experiment. The end product of such imagination is the kinda dreamy, hypnotic currents that underpin tracks such as Your Room, Is It Any Wonder or Roadside. I'll definately be listening out for more in the future!

On Tuesday, The Australian (who does not reside in the National Homeland, coincidentally) had been thoughtful enough to get us tickets for the Guardian debate on the limitations of free speech, entitled 'Free To Offend?'. This is something that I am suffisciently interested in to have written about it twice before on this blog. The debate was chaired by Gary Younge - one of my favourite journalists, who I was shocked to discover is actually the size of a small house - whilst the panel consisted of Ziauddin Sardar, Trevor Philips, DD Guttenplan, Salma Yaqoob, and Will Hutton. They all made some interesting points but the one in particular that stuck in my mind and challenges my relatively absolutist view of the freedom of speech was made by Ziauddin Sardar in relation to power imbalances in the distribution of freedon. He pointed out that if we expect to have the freedom to disregard the sacred values of another culture - for example, as in publishing cartoons that denigrate the image of the prophet Muhammed - then we must accept that another culture has the freedom to disregard the the sacred values of our own - for example, as in the protests against complete freedom of speech. Some poor Indian guy in the audience fell foul of the crowds when he tried to hold up secular India as a model of cultural integration where muslim, hindu, sikh and christian all walk hand-in-hand while the birds sing and the sun shines above. Sadly, he omitted to mention Vishwa Hindu Parishad, the clashes with Muslims over Ayodhya, the destruction of the Babri Masjid, petrol-bombed trains, the Hindu-Christian clashes in Gujarat, or, indeed, the disputes over Kashmir itself, to name but a few. Ooops. A portion of the audience errupted in fury and, if he had any point other than this, then it was lost in the furore. It seems, therefore, that we are free to speak, so long as what we speak is the truth.

Political Philosophy for Poofs

2006-03-12T16:26:00.000Z

I note with approval the arrival of the new Dolce & Gabbana advertising campaign on the giant Charing Cross road billboard. There’s nothing like swinging round the corner of Oxford street to be confronted by enormous, semi-naked paragons of male beauty. Naturally, they’ve thrown in the odd dolly bird for the amusement of the straight populace but nothing so garish as to distract from the chiseled jaws, ripped abs and olive skin. The purposeful sexual ambiguity is made explicit in the male and female hands both draped over the taught, hairless chest of the modern day Adonis that sprawls across the bottom of the poster.

I would like to stand and look at it for longer, but then I suddenly remember that I have far too few D&G clothing options in my wardrobe and double back on myself in the direction of Bond street. At these moments in life I can only breathe a sigh of relief that I don’t live in Poland. Apparently the country has gone to the dogs; or, to be more exact, it went to the right-wing Law and Justice Party - also known as Prawo i Sprawiedliwość or PiS for short - in the elections of September 2005. In addition, the populist Samoobrona and the extremist and rather sinister-sounding League of Polish Families recently signed a solidarity pact with the amusingly-named PiS party to prop up its minority government. Then again, the party boss, Jaroslaw, and the new president, Lech, couldn’t have a closer relationship, politically, ideologically or genetically: they are monozygotic twins. For the brothers Kaczyński, politics is in the blood.

Not good news for Poland’s homo communities, alas. Lech, in his former role as Mayor of Warsaw, had already made his antipathy towards Polish poofry evident when he refused to authorise a pride parade in June, 2005. When its organisers requested a meeting to discuss the reasons why, he responded that “he was not willing to meet perverts”. Hmmm…a diplomat of the Prince Philip variety there, methinks. They decided to go ahead anyway but, sadly, were met with a hail of rocks, bottles and verbal abuse thrown by young members of Młodzież Wszechpolska, an organisation associated with the League of Polish Families. At least two of the participants required hospitalisation, and several dozen more probably had their new D&G tightie-whitie T-shirts ruined by troublesome blood stains.

Now that Lech, Jaroslaw and the PiS party have been handed the reigns of power, it is clear that we can expect more of the same. They were off to a running start when they abolished the Office of the Government Plenipotentiary for the Equality of Men and Women, which also promoted equality of homosexuals. Now they are suggesting that queers should not be allowed to take up jobs where they would come into contact with children, such as a school teacher. Ah yes, my all time favourite: that wilful lack of distinction between the terms homosexual and paedophile. It’s the year two-thousand and fucking six, we claim to live in a rational, inclusive, cosmopolis, and yet people – and not just people but heads of national governments - are still trotting this one out. It’s just crazy!

Nor are PiS a particularly shy party when it comes to making their opinions known. Jaroslaw told to the Polish weekly Ozon: "The affirmation of homosexuality will lead to the downfall of civilization. We can't agree to it." Downfall of civilisation, you say? Goodness, sounds bad. Who’d have thought it? You start off by letting two men hold hands in the street and before you know it the whole of mankind is poised to plunge backwards into benighted barbarity. Kazimierz Marcinkiewicz, faithful lapdog and trusted Prime Minister of the brothers Kaczyński, confirmed that he was ‘on message’ when he told Newsweek that homosexuality is "unnatural" and also threatened lesbians and gay men with "state intervention" if they tried to "infect others with their homosexuality." Infect somebody with homosexuality? Gosh, it really throws the worries about Bird Flu into a new light! And ‘state intervention’ – what exactly does that mean? Perhaps history can point us in the direction of the form this might take? Maybe something along the lines of the notorious Hyacinth law enforcement action, which began on November 15, 1985, at the behest of Czeslaw Kiszczak, Internal Affairs Minister of the then-ruling Communist regime? It lasted for two years, during which the police, then called the militsiya, gathered information about some eleven thousand homosexuals, many of which they interrogated and fingerprinted.

Hmmmm, maybe I’ll keep Poland off my list of potential holiday destinations just for the moment. It’s terrible shame really: I hear they have such great vodka over there...but,unfortunately, absolutely no homoerotic Dolce & Gabbana advertising campaigns. poland homophobia gay protest

Hell in a Handcart

2006-03-10T14:42:00.000Z

Nurses are, as a rule, the strangest of creatures. After a long period of close-up observation of the Gorillas in the Mist variety, I have come to the conclusion that a nurse's personality might come in one of two basic flavours. Either they have all the independence and problem-solving abilities of a 2 month old baby or, alternatively, they are sadistic mini-Hitlers whose sole reason for entering health care was so they could get closer to the misery and suffering that feeds them. Mini-Hitlers tend to be found in high-dependency or intensive care units where they think that just because they know how to look after an arterial line or turn up the PEEP on a ventilator they have mastered all there is to know about medicine and could run the entire unit with their eyes closed. Some mini-Hitlers have been given the freedom to seek out victims for their powerplay all over the hospital: these are the nurse specialists and the site practioners. Only last week I got into a showdown with tissue viability nurse because I refused to start anti-pseudomonal antibiotics on her orders:

"The ulcer's infected with pseudomonas"

"Really? Have micro grown something already."

"No. But I can see that it is. You should start tazocin"

"I think we ought to wait for the swab"

...Stony silence....tumbleweed rolls past...

"I know what pseudomonas looks like and this is pseudomonas."

"All the same..."

And when three swabs in a row came back negative did she apologise? Did she fuck! Nor did mad Sandra with her mad thyrotoxic eyes in her mad hysterical head who kept bleeping me constantly through the night because some chaps blood pressure was either a couple of millimeters too high or a couple of millimeters too low. Don't you understand - I felt like screaming down the phone - I don't fucking care...call me when he's dead! I imagined her index finger blistered and red from hammering out my bleep number every five seconds. Bitch.

Anyway, all that is finished for a little while at least and the weekend beckons. I go into it a little under par unfortunately after a routine drinking session last night got out of control and the Pink Psychiatrist and I ended up swaying glass-eyed on the dance floor of the Shadow Lounge. The Pink Psychiatrist was sufficiently intrigued by a Death-In-Venice style blond waif with a preposterous mountain of thick hair on his head that he forced us to go and talk to him. Unfortunately, he had either had his brain wisked in utero or was on a huge quantity of drugs as nothing he said actually made any sense and his affect was so euphoric as to be pathological. We decided it best to leave Tadzio alone with his hallucinations.

We ended up hitting the sack around 3:30am. I felt sorry for The Pink Psychiatrist when I heard him get up at 7:30am. Medicine is such a cruel task master.

Carnage

2006-03-05T14:37:00.000Z

This weekend has been spent catching up with old friends. As is the sacred, immutable tradition of time immemorial in England, this re-acquaintance was facilitated by lashings and lashings of alcohol. The clear advantage of getting absolutely hammered is that the entire evening is nothing but a pleasurable blur and nobody need ever think of anything new to say since it will all be forgotten by the morning.

Naturally, there will always be casualties. There can be no pleasure without pain. Friday night was unusually violent though. It was an evening which confirmed to me that, whilst we are all in the gutter and some of us may indeed be looking up at the stars, there is a whole other class that is face down in a puddle of their own vomit. It is to that latter class that my friends and I undoubtedly belong. Having briefly considered such fashionable haunts as Brixton, Clapham and Old Street, we plumped instead for the Weatherspoon's at Elephant and Castle. The Met Bar it was not. Perhaps that wasn't such a bad thing in retrospect. I doubt the staff at the Met Bar would have watched Paulo vomit explosively over himself and the table with an air of such sanguine resignation. Sadly the Stella-Sambuca depth charge had proven to be the straw that broke the camel's back and poor Paulo had to stagger off to the tube station covered in vomit and shame. The remainder made it to the Ministry but by morning the other two had also succumbed to rebellious bellies so that only I had not seen the inside of toilet bowl at close quarters that night. Natural selection, that's all I'll say.

On Saturday, we had cocktails at home to honour the return of Benhamino after so long an absence. This time it was the Pink Psychiatrist who took both barrels of the alcohol gun squarely in the face. In three hours, the three of us munched our way through 1 bottle of vodka, 1 bottle of cointreau, 1/3 bottle of gin, 1/3 a bottle of rum and 1/4 bottle of tequila. The Pink Psychiatrist slipped off to the toilet near the end - ostensibly to put his face on - but after 20 minutes I began to suspect that it was not a natural calling that had summoned him to the bogoir. I found him collapsed by the side of the toilet with dysconjugate eye movements and a distinctly unpleasant pallor. He managed to bounce off the walls into his room before collapsing face down into his bed and lapsing into a stupor. Instinctively I took this to mean that he would not be accompanying us to Heaven after all. Benhamino and I went and had a good time all the same.

Charming weekend. Just a shame they go so fast.

Accidental Overdose

2006-03-01T19:47:00.000Z

Unfortunately I was unable to attend work on Tuesday. I awoke to find myself in a most deplorable condition. I was exhausted; my body ached from tip to toe; my eyes were swollen and sore; my stomach turning over in open rebellion; my head felt as if it might well cave in at any moment under the pressure of the vice like pain which was only partly assuaged by remaining perfectly still. There could be no doubt about it: I had the mother of all hangovers - but how?

As I slowly reached over to silence the clearly rather ambitiously programmed alarm clock, I began to piece together the preceding evening in fleeting images. Yes, dinner, The Pink Psychiatrist saying we should go out, just a couple naturally, me nodding my acquiescence as I pour the Hoegaarden. Then Retro Bar, pint, pint, two love birds writhing around on the couch opposite, time to go. Next the disconcertingly lit cave of The Friendly Society, jug of beer, cheaper that way, the life coach sidles on up, watching The Pink Psychiatrist bite on his tongue each time he gets called a psychologist, bored of this weirdo, move on. Trashy GAY Bar, packed as usual, all manner of creatures, some so nice, where's the Australian, pint, ah there he is, pint, pint, talk of Heaven, pint, yeah Heaven yeah, the evening is suddenly so young, a taxi to Heaven, let's go!...

It all dissolves into a whirls of coloured lights, staccatos of heady beats and waves of hideous nuasea. I call one of the SHOs, crawl on my belly (literally - as well as metaphorically - to minimise the pain) and beg him to cover my job for the day. The guilt is overpowering, but probably not as overpowering as the smell of stale booze would be were I to go in. He agrees and I crawl back to bed to finish off dying. My back-up radio alarm fades up to an painful volume. It's too far away to turn off. Guy Garvey's melancholic voice fills the room and my mind as he sings through the tumbling chords of Elbow's 'Red':

'You burn,
too bright.
You live,
too fast.
This can't go on too long!
You're a tragedy starting to happen.'

Hmmm. I know then that I'll never, ever drink again...well, at least not until I feel better.

Le Nozze di Pieman

2006-02-26T11:55:00.000Z

I've just had the pleasure of bumping into Dr D&C in the corridors of our hallowed institution. Long time, no see, as they say. We went for a coffee and a chat; and, for a little while, I might well not have been trapped in the hospital on call. Sadly he is not as unemcumbered with work this weekend as I and had to return to his labours promptly, leaving me at a loose end again.

Another friend of mine also provided me with some happy news this week. The Pieman has finally desisted in the riduculous charade that was his denying that his marriage to his very long-term girlfriend was not an immenent inevitability; he has gone and got himself engaged. About bloody time is all I have to say on the matter. I am already relishing the thought of the bachannalia that will be his stag do. In fact, I have little doubt that most of our friends reacted to the good news by formulating plans to pour the maximum amount of booze down the Pieman's neck (and, indeed, I am partly convinced that it is this very fact that has delayed their engagement for such a long time)! My sole advice, Pieman, would be to make sure the stag do is sufficiently separated from the wedding so as to accomadate a short stay in hospital and a protracted and painful recovery without any disruption to the happy plans.

Speaking of marriage, I stumbled upon an American, right-wing blog called Opinionnation Times yesterday which reminded me that England has been surprisingly progressive in adopting the civil partnership. Over in loony land, the religious right are still getting all het up about the alledged debasement of the sanctity of marriage that would occur if two poofs were afforded the legal rights of married couples. Apparently the very greatness of America is set to crumble because of it. Honestly! The melodramatics of the right never cease to amaze.

Stripped of its religiosity, the core of marriage is a public avowal of commitment. With this pubic avowal come state-protected rights that have important implications for gay couples, legally, financially and socially. It is not fair to deny people these rights on the basis of outmoded prejudice concerning the acceptability of homosexuality as a lifestyle. In the end, it is to the benefit of society as a whole if people - gay or straight - are encouraged to enter into lasting, meaningful relationship and a legal bond is a excellent way of cementing that relationship and preventing people just walking away after the slightest hiccough. For once, England and the current government ought to be proud of itself for its forward thinking on this one.

Prisonner Cell Block H

2006-02-25T14:48:00.000Z

Sigh. Back on call again. It's the weekend so there's nothing really to do.

Just sit.

And stare at the clock.

While the hours slowly slip by.

I devoured the paper too hastily this morning. I should have paced myself so that it lasted me the day but, in my eagerness to read about the dethroning of Red Ken, I accidently gobbled the whole thing up with my eyes like a greedy child. It seems a terrible tragedy that the Newt could be so unceremoniously deposed by three humourless functionnaries. So he got unlucky when he picked a Jew to hold up in comparison to a Nazi concentration camp guard, but you can see what Livingston was getting at: that disregard for people justified by a claim 'only to be doing one's job'. I think Mr Fieldgold's overly-precious indignation at the comparison is slightly non-sensical and, in reality, probably journalistically expedient. How can it be considered anti-semitic to hold the Nazis up as an example of immoral inhumanity? Unless I miss the point and it has now become a crime to say anything nasty to a Jew full stop? Once the victim, always the victim, perhaps?

Anyway, I still have no computer after becoming the victim of some technophilic theif two weeks ago. I've been looking for a new one today and I think I might go for the Fujitsu-Siemens Amilo A1167G. I miss downloading random music too much to go without one again. Anybody know anything about laptops that might want to give me some advice?

For Neither Love Nor Money

2006-02-14T15:35:00.000Z

My! It's an expensive business this Valentine's malarky, isn't it? Treating your baby right certainly don't come cheap these days. Being and Australian I'm sure the wife would be quite content with a tin of Castlemaine and a few barbied shrimps but, as a thoroughly indoctrinated consumerist, I can only ever see the failure to spend sums approaching the GDP of a small country as some sort of dereliction of duty and possibly much akin to a kick in the teeth.

I had decided that that it might be nice to take in a show; it's bloody lucky then that I have the same zeal for economising as Elton John and the Aga Khan put together. One hundred smackers for two seats to see the Producers. Not even the best seats either, but suspended ectopically in the grand circle. No doubt I'll require the Hubble telescope and an ear trumpet to follow the action of the ants on stage.

I also had the bright idea of cooking a dinner for beforehand. I consulted Hell's Kitchen, the cookbook by Gordon Ramsey bought for me as a Christmas present. I quickly learnt leafing trough the glossy pages that the bad-boy of haute cuisine had decided not to limit the scope of his counsels to the art of stuffing a goose and the likes. Oh no, Gordon had far greater pearls of wisdom to impart than basting techniques. One of the culinary sage's little off-topic gems is that nobody ought to sleep more than 4 hours a day. Now, quite frankly, if even the remotest of possibilities exists that Ramsey's leathery fass might in some way be the result of those self-imposed deprivations of beauty sleep, then that should be suffiscient to warn even the most naif ingenu off choosing this role model. For God's sake, the the man is only 39 and yet the skin on his face looks like it wouldn't be out of place on the backside of a particularly sun-exposed rhinoceros. Forget the Grand Canyon, why not take a day trip down any one of the cavernous ravines that cover Ramsey's crumpled facha? I mean, does he really think that it's his verbal onslaughts that people are winching away from when he gets all up-close and personal? I think not.

Thankfully his sirloin of beef with roasted charlotte potatoes and and red wine shallots looked a damn sight better than he did, and so I opted to serve that one. Still, not something for the financially light hearted with the ingredients weighing in at a lean £60. Then again, what price love, I ask you?...and as you can see love and good-will is something that I'm just bursting to give.

Outrage Perpetrated Against Venial Sinner!

2006-02-13T17:36:00.000Z

They came in through the window. At first glance the only sign that there had been anybody there at all was my absent laptop and an upturned house plant smashed on the floor beneath their entrance point. A more thorough search revealed that they had made their gettaway additionally burdened by my digital camera and, rather ludicrously, around £50 in copper that the Pink Psychiatrist and I had been hoarding in our respective boudoirs. My initial reaction to this outrage: that same flat dysphoria that I had felt all those years ago in a back street of Camberwell after a particularly comical knife-point mugging. None of this wild, inconsolable grief; no murderous bloodlust for vengence; not even a whimpering exclamation of indignation: just a simple, recognizant "oh." and the immediate desire to have done with the whole inconevient business of reporting it before I'd even begun.

The police were very efficient. I wasn't even sure if one called 999 for this sort of thing; it didn't particularly seem to be that much of an emergency, to be frank. Two genial officers of the law arrived promptly and managed, to their credit, a half-decent job of suppressing their what-do-you-expect smiles as they catalogued our stupidity: door not dead-locked; window left ajar; alarm not set; possessions not insured. I thought perhaps I might lighten the uncomfortablely official atmosphere by assuring them with a wry smile that now that the horse had bolted I would definately ensure that the stable door was not only closed but dead locked and alarmed as well. This went down life a pork chop at a bar mitzvah and I decided the simple facts would probably be best.

Later some lady turned up with what looked suspiciously like her personal make-up kit to dust things for prints and the like. I showed her in and left her in peace to get on with this little exercise in futility whilst I consulted the Daily Fascist, er I mean Mail, to put together my own photofit of the criminal at large. I learnt firstly that it was undoubtedly young and a he. Young because - as any decent, tax-paying, Daily Mail reader knows - the younth of today are, without exception, a riotous bunch of amoral ruffians who trawl the streets in hoods looking for old grannies to rape or war veterans to disrespect. They don't even speak proper English, but some incomprehensible pidgen called 'txt'. It must have been a he because the female-species of criminel - a.k.a. the single mother in Daily Mail speak - is known to keep her pecuniary trespasses on a State-wide, rather than a personnal, level in the form of benefit fraud...or even just benifits full stop. He will undoubtedly be involved in drugs, perhaps even the really hard stuff like cannabis, which we know will turn even the most proper of individuals into ravernous, robbing rapists at the slightest whiff. Worse still he is probably an illegal immigrant that has escaped from one of those nice holiday camps by the sea that those moaning, woolly liberals keep stupidly comparing to prisons! As for the colour of his skin, it's more difficult to be sure these days. Time was you could be almost certain that it would have been black; these days one discerns a certain lighter, more olive hue to the modern ne'er-do-well. Satorially, this criminal master of disguises has swapped his overly-baggy jeans and visible underpants for a beard and turban. Lord knows, he may even have a had a hook for a hand to help him scale the wall to the window! If only that poor forensics lady knew about the Daily Mail Bureau for Criminal Statistics, she could have saved herself a whole lot of time and powder by immediately arresting the man below.

Of course, all this still leaves the The Venial Sinner sans computer and, thus, sans means of updating this literary opus of mine. Somehow, however, I think the world might just manage without me...

The End Cometh!

2006-02-08T04:21:00.000Z

Thank the Lord! In 3 hours and 30 minutes I am released from the gruelling physical and psychological torture that is a week of nights. I shall burst forth onto the London streets and roll about them drunk with freedom. There will be sunlight. There will be flowers. There will be polite society with which to mingle!

Actually, fuck polite society! It's that very impolite society of the London drinking dens and meat markets that I crave now. To rejoin the endless saturnalia of those plastic poofs that swarm about the city centre on the prowl for a trick. Or to sway in dark and seedy rooms cloaked in bland and featureless buildings, intoxicated by the smell of sweat and sex and the hypnotic rhythms of an insistent bassline. Eyes darting; ever-alert, ever-moving, never-staring. Seething animal instinct beneath a rapidly-thinning veneer of respectability. The art of being disinterestedly interested.

No more clerking. No more Venflons. No more bleep bleep bleep of that stupid black box. No more sickness and dread at the thought of going back to my prison. No more.

A week of freedom is almost mine and fuck will I enjoy it!

From A Distance...

2006-02-07T05:54:00.000Z

Sometimes on nights I have the feeling of inhabiting another place. Not a parallel universe so much, but some other imperceptible dimension, superimposed on that of the everyday world like a sheet of acetate on some pretty picture. My life is split between the dual confinements of my darkened bedroom and the eerily-quiet hollows of the hospital at night. My only glimpse of the outside world is from the grimy window of the bus I take to work each evening and home again in the morning. I speak to no-one. I am like a ghost that is compelled to relive some fatal journey in ever-repeating solitude amidst the insensible crowds.

It is no small surprise then that, from such a detached vantage point, I have watched the unfolding drama of the Muhammed cartoons with a growing sense of perplexity and fear. Has the world gone completely mad in the 6 days I have so far spent in isolation? Surely it must. For how else can I explain the rabid reaction that has greeted the publication of several cartoons which depict the prophet Muhammed in various terrorist poses? Are not there embassies being burned to the ground because of it? Are not there threats against the lives of those responsible issued daily? Are not there people baying for blood, clamouring for their pound of flesh?

I do not deny that the cartoons were provocative. Indeed, at a time when many people are working hard to save the everyday Muslim populace from becoming the victim of overly-facile ideological links between them and the various terrorist attrocities comitted in the name of their religion, it is quite probable that they were even rather ill-advised. The fallout, however, has been out of all proportion to the actual insult. The right to freedom of speech is paramount. That includes the right challenge others over their views and actions. If people have a problem with the cartoons, then they are free to raise their objections peacefully. They may debate. They may argue. These are the acceptable means of protest. Burning embassies to the ground and calling for the assassination of the author are not. The cartoons seem to insinute that Muslim and terrorist are one and the same. That is clearly wrong and deserves to have been challenged. However, by enagaging in this orgy of violence, which increasingly seems to have snowballed out of control, these people do nothing to help dispell the inaccurate image that they claim to be the source of their grievences.

I cannot help but be worried by the seeming sacrifice of our secular liberal rights on the altar of religious absolutism, be it of a Christian or Muslim flavour. I have said it before and I will say it again: there is no good reason why we ought to shy away from questioning somebody's religious beliefs. They are but ideas and should be open to challenge like any other. If the current trend toward religion becoming an off-limits topic continues unchallenged, we will have unwittingly transformed it into some sort of state-sponsored dogma.

Knight's Move Thinking

2006-02-06T05:53:00.000Z

One of the nice things about nights is you have the time to chat to your patients. Take for example this bemusing exchange that I just had with a man who looked not unlike a cross between dungeon master and a malevolent Paul Danniels.

"Hello, Sir. How are you doing?"
"I piss myself every 10 minutes with fear but you know that already, don't you"
"I'm sorry - what was that?"
"Oh yeah, that's right - going to pretend you don't now know, are you?"
"Know what, Sir?
"That they're threatening me, just like you are now."
"Who's threatening you?"
"The man who wasn't there just then"
"Wasn't where? Why do you think I'm threatening you? We're just chatting."
"I don't know why you're like that. You're all like that. I'll draw attention to the earlier incident if they try to bill me"
"Bill you? What for? What earlier incident?"
"He wasn't happy when he found that that they'd got my glasses in their locker but none of them was billed for it!"
"I think you're a bit confused, Sir - do you know where you are?"
"Yes, Tibet. I'm in Tibet every Thursday"
"Tibet?"
"Yes...or Surrey."
"Right. Maybe you should get some sleep."
"I would if that man that wasn't there just now would stop trying to scare me to death. I know what you're about in here. But then so do you. You know everything that's gone on. I shouldn't be surprised if you're behind it all."
"I'm a doctor. We look after sick patients here. This is a ward full of sick patients, like yourself."
"Well I supposed that's what you tell people on the outside. Luckily I notified my lawyer and if anything happens to me, he knows to take it all the way to the top."

At this point I'd had my fill of this lunacy and ordered that lashing and lashings of haloperidol - that great soother of agitated minds - should be injected deep into his left buttock.

The End.

The Witching Hour

2006-02-05T05:07:00.000Z

Ah, nights - ya gotta love 'em!

Well, actually you don't. They're shit. I am but half way through my punishment and I've already had enough. Here in the rarified surroundings of my hallowed institution, we get to cover both neurosciences and neurosurgery at night. One can only imagine how thrilled the patients, their famillies and attendant lawyers would be to learn that the doctor looking after them doesn't know a monkey's fuck about what has or is about to happen to them. By now I've given up trying to delicately bat away questions about what exactly various surgeries entail and have instead decided that it's far more fun to just make up what I think my happen. Spinal decompression, I explain, is much like loosening your tie and undoing that top button on ya shirt when you've got a headache - it gives the cord a bit more room to breathe, see? Nobody seems to care anyhow.

Most of the work is mundane. Like a machine I process the new admissions, producing beautiful crafted clerkings for elective surgical patients that I know nobody will ever read. What do the surgeons care if vibration sense is decreased in the left leg or there's a hiss of mitral regurg? All they do is drool and dribble over the prospect of fresh flesh to cut. A starved patient with a beating heart and normal bloods will do them just nicely thank you.

Still, there is the odd bit of fun to keep you ticking over. Last night one of the epileptics went crazy. I heard the nurse screaming as I was cannulated some old dear down the corridor. I popped my head round the door just in time to see Cathy being chased into the female bay by a man wearing only white briefs, screaming in Italian and waving his clenched fists around in a murderous rage. In the carnage that ensued we managed to wrestle him to the ground but only after he'd knocked one old dear flying off her commode, sending a river of rancid piss dangerously close to my knees. Somehow he'd managed to bite his tongue and, as he arched his back and writhed under the weight of four burly security guards, blood pouring from the sides of his mouth, alternating between blasphemous Italian and maniacal laughter, I did have the distinct in impression that I might be in a remake of the Exorcist or the like. In the end it took one and a half hours and 50mg of diazepam i.v. to fully exercise his demons, after which he was carried like a limp rag doll and dumped back on his bed to 'sleep it off'. Cathy complained loudly that she needed danger money to do this job and I nodded soothingly and reassured her that diazepam is long-acting. All the same, it beats clerking.

¿Qué Jesús Haría?

2006-01-31T23:36:00.000Z

Tomorrow I start nights. You'll learn all about them in good time, I'm sure. For the moment though I wanted to do something I've never done before and ask people's opinion on a situation that arose last week.

I'm going to be as brief as I can because I want to go to bed:

I was out drinking. I saw another guy there who I thought was really attractive. I imagined that, were I not in a relationship already, he would be the type of person I'd really fancy. I stood up and realised he was in a wheelchair. I was suddenly no longer attracted to him.

I felt extremely guilty for a moment. It passed.

Do other people think, or know, that they would have felt like this? Is it only natural? Or horribly unfair?

What say ye?

Out of Control

2006-01-27T18:44:00.000Z

I needed drugs to get going again this morning. I awoke to find I had developed a chemical meningitis of the Stella variety over night (known otherwise in the lay parlance as a Stella head). Thankfully, being a doctor, I have accumulated a handy stash of all the ingredients necessary for a concoction that can restore me to some minimal level of functionality: aspirin, paracetamol, metoclopramide and lansoprazole. Sometimes I add a multivitamin, but I know that this is mere garnish for the chemical goodness that forms the true meat of my panacea.

I droned through the patients histories at the consultant meeting as is required of me then lapsed into an absence while the Neurobeasts clashed horns over who knows best about what should be done. It was only then that I realised what an odd looking bunch they are. A few in particular are visually arresting: there's the sickly pale man with an autistic affect and a malevolent stare; a stern-looking bull dike with a face like a greedy beaver; and some damp squib who looks like a puppet with its strings cut. I tried not to stare too much, especially with my stomach as unsettled as it was.

All the patients were miserable today. I suppose they have good reason: none of them can move from the neck down anymore. Strangely enough this wasn't really the focus for their misery at all. The reason they were so sad is shit. No, I mean it literally was shit; or the lack of it to be more precise. The same process that had deprived their bodies of sensation and power had also deprived their bowels of any automaticity by damaging the autonomic nervous system. The shit wasn't going anywhere. My poor sweeties hadn't had a good poo for over a week, bless 'em. They'll need the works: laxatives galore, daily enemas and possibly a manual evacuation or two. The latter is very much a last resort, predominantly because if it comes to that it's my hand that has to do the evacuating! I'll certainly need some metoclopramide for that one, I tell you.

It's kinda sad how tragic and pittiful we are when our bodies break. Our greatest joy, our dreams and desires, all intimately linked to the production of a well-formed stool. Reduced to reliance on others for everything, we lose all dignity and control. We are left at the tender mercy of others; their whims and their caprices replace our own as the deciding factors in our destiny. Today one of the patients thanked me repeatedly for nothing more than having moved her leg for her. It had become torturously painful in its former position but she had no way of moving it herself. She had asked the nurse to rearrange her but the nurse needed somebody else to lift her safely and there was nobody free; she'd gone to find somebody but got distracted along the way and not yet returned. I found the patient quietly sobbing. After I'd moved her, I said it was no problem, smiled and inwardly thanked the fates that it wasn't me in her place. I knew it wouldn't be long before her new position becomes just as torturous and I sighed as I wondered how long this time would she lie helpless and in agony before somebody was free to move her again.

A Second Opinion from God?

2006-01-25T21:56:00.000Z

In the last 3 months, I have done many of the everyday things that a 26 year old might do. I have been ice skating, gone dancing, caught a show at the theatre, seen numerous films, worked my arse of, and lazed around on the couch to name but a few. All well and good, you might say. Sharon is the same age as me and previously her life was little different. She probably even had a little more fun: there's a history of cocaine and ecstasy and the hope of a career in the fashion industry. Recently, however, things have been a little different for Sharon. For the last 3 months, she has been in a encephalitic coma. Her only trips have been to the ICU and HDU. Considerably less well and good, I might say! Nobody held much hope for poor Sharon.

Imagine our joy then when she started to improve at the end of last week, culminating in her opening her eyes of Friday! This week, to everybody's amazement, she started to talk. OK, so she's not quite there yet - there are psychiatric and cognitive problems, which may or may not get better, and most of her speech involves telling people to fuck off - but it's a start and she may improve still more.

All the same, we still need to know what has caused this illness, if only because the symptoms were so odd that finding an organism may help us to treat any future victims with this very atypical clinical picture. We have a single lead: an area of infective looking tissue on CT which we could biopsy and culture. Sharon cannot consent to the procedure; she does not currently have the capacity. In the morning, we spoke to her mother who agreed that the biopsy should go ahead all the same and that she would consent to this in place of her daughter (as the law allows).

That was the morning. By the afternoon everything had changed. Sharon's mother had some news. She had gone to the church and spoken with the Elders. The Elders has listened to the story, considered, and pronounced their verdict. Sharon had had no brain infection. God punishes those who live dissolute lives and Sharon had taken drugs. God does not like drugs. His punishment had been severe but he had heard the prayers of Sharon's mother and, being a good and merciful old chap, he had relented. Sharon would recover and all would be well. There was no infection and, ergo, there need be no biopsy. Sharon's mother, a devout Christian, swollowed it whole. She withdrew her consent for the biopsy immediately. Now our last chance to find our what had caused this illness will dissolve away as her body clears the infection.

We could still do it, of course, but we won't. It's not worth the trouble of a court fight. Besides, it's not really fair on her mother. It's not her fault, after all, but the preachers who interfere in areas where they have no expertise. It's bad enough that they profess superiority in the moral arena, let alone in the understanding of medicine. The consultant psychiatrist whose job it is to assess a patient's competency sees this often. He is annoyed but resigned. He knows that people are vulnerable at this time and we cannot always give the exact answers they crave. Preachers like these feed on uncertainty; they've had a market-share in plugging gaps in human understanding since time immemorial - it's their raison d'etre. Yet, the most disgusting fact has little to do with the biopsy. Without a qualm, these finger-pointers have pinned the blame on poor Sharon for an unpredictable illness of which she is an innocent victim. How unfair. How cruel. What bastards!

"Balls like watermelons, I tell ya! Watermelons!"

2006-01-22T15:14:00.000Z

I am so extraordinarily bored that it hurts. I'm on call, but it's an on-call like none I've ever done before. There is absolutely nothing to do. I'm only looking after about 12 patients, all of which are perfectly stable and require no active input. Yesterday I sat in my office from 8:30am to 8pm with only one foray onto the ward to put in a cannula and write up some paracetamol. Today I have not even done that much. My flatmate, The Pink Psychiatrist, has been doing on-calls like this ever since he defected to the Dark Side, a.k.a. psychiatry. Whenever one was coming up, he'd forever be moaning on about how terrible they were. Being a medic myself, I'm used to being run off my feet on an on-call and coming home exhausted. My standard retort was that he should count himself lucky and shut his bastard gob! Until now, that is. Now I know how torturous it is to be trapped in a place with diddly-squat to do.

I've read the entire Sunday paper plus supplements. I've listened to the radio. I've phoned my family and friends. I've drank so many hot bevrages and been to the toilet so many times that I'm beginning to wonder whether I should just bypass the middle man and throw the tea down the toilet as soon as it's made. I've even dusted off ye olde textbook of Neurofuckedology I found on the office shelf and done some work! All that and still only half way through with sweet fuck all to do. It's like being in prison.

Still, at least the papers were good. There's nothing like a good sex scandal to pass the time. It would seem that Mark Oaten has come a bit of a cropper over his liason with a young renter he met through Gaydar. Of course, the irony of the whole thing is that Gaydar is actually just an on-line meat market where literally hundreds of thousands of people offer themselves up in the hope of a quick shag...oh, sorry, I meant a 'meaningful relationship'. So why was this numbskull paying 80 smackers a pop? Really people that stupid deserve to be caught. And what was he thinking anyway? As if some street urchin that sells his arse for a living is going to have the moral compunction to pass on the opportunity of a tidy little earner just because it involves selling one of his clients down the swany. I can just imagine the kkk-ching! of the dollar signs in his hollow eyes the moment he realised that the baldy old slug with the penchant for football kits was actually a potential leader of the Lib Dems. Still, I can't help feeling a little bit sorry for him: imagine being exposed by a paper with a title as patently preposterous as "The News of the World". I mean as if! Anyway, I'm also rather disappointed in Mr Oaten. Not because of some moral revulsion on my part at his perceived failure as a role model; politicians are hardly the greatest of role models whether they are out shagging homo renters while their wife sits at home alone or not. No, I'm disappointed because of the lack of ridiculously implausible excuse proffered to account for his misdoings, a la Ron Davies' badger spotting or Kevin Spacey's dog walking. It's these aliens-stole-my-homework type excuses that are the punchline to the eternally-great joke that is another's fall from grace. To just admit to it and say you're sorry is to rob the people of their bread and circuses. Bloody Lib Dems: you can always rely on them to get it all wrong!

Chronic Fatigue Syndrome

2006-01-20T18:34:00.000Z

No, this is not one of those articles in which some doctor - inevitably subsequently described as 'unhelpful' and out-of-date' - dares to suggest that chronic fatigue syndrome is really nothing more than a big pile of made-up poo. Certainly not...I would never suggest such a thing. I would never suggest it because I know that chronic fatigue syndrome exists and I know that because I have it. I am tired right now. I was tired when I woke up. And I'll probably be just as tired when I wake up tomorrow. In fact, I am tired pretty much all of the time.

Is this surprising? Well, not really I suppose. My job is busy, busy, busy. I haven't had any lunch for the past three days, let alone a coffee break. There isn't enough time to do everything I'm supposed to do in my working day so I end up staying late. Last night I left at 8pm when I'm supposed to finish at 5pm. That's nothing too unusual. The hospital managers recently thrust diary cards in our direction to check how many hours we were working. Don't be fooled - this isn't so that they can accurately assess the size of the problem of too-much-work-too-few-people before doing something about it. Oh no. Diary cards exist only to make sure that they are not paying us a penny more than they have to by law. The idea is that we record what hours we work each day and what we were doing and then they pay us a intensity supplement if the job necessitates a lot of out-of-hours work. Except that's not quite how it works. The problem is that everyone works so terribly hard that those cunning foxes in management have had to devise some wily tricks to ensure that people feel obliged to minimise the extent of their voluntary overtime. Take the last set of cards I filled in; they carried the following in bold at the bottom:

"Please note: only the hours that you are required to work should be recorded. If you are consistently required to work out of sheduled hours this must be raised with your consultant and a solution put in place prior to completing these cards. If you stay behind later or arrive earlier than you are scheduled to, this is a voluntary choice and should not be recorded."

Riiiight. So I get what you're saying here. I stay behind at work because I love it so much that I just can't bare for it to end and, besides, I've got absolutely nothing better to do with my time because I have no existence outside of the hospital. Of course, it has nothing to do with the fact that there isn't enough time for one person to do all the work required to look after the patients properly. No, nothing at all. Absolutely nothing to do with that fact that I know very well that if I didn't stay behind then Mrs Smith wouldn't have her CT because nobody would have discussed and ordered it; Mrs Jones wouldn't get any antibiotics because nobody would have wrote them up and put the cannula in; and poor Mr Kent might die because the even-more-ridiculously-outnumbered hospital at night staff wouldn't have got round to considering his lack of urine till the wee hours of the morning. Nope, it's all for the thrill of the medicine that I'm here till late.

My arse.

Essentially the statement above ensures that the only acceptable way to fill in the diary card would have been to copy out my rota verbatim. That way the hospital managers can claim to be reducing hours while doctors work late into the evening on a supposedly voluntary basis. If anybody dares to suggest that they simply couldn't leave or the work would never get done, they are told they should hand over what they cannot do in the day to the night team. Yet, the night team is a pitiful skeleton crew and no decent human being with a conscience would be able to walk out the hospital having left it to those wretched souls to sort out all the left-over shit. If everybody were to do so, the entire system would simply buckle and collapse. But then perhaps that's what it needs. Perhaps we ought to do exactly what they say and hand whatever we can't reasonably fit into our working day over to the night team. Then, maybe once a few people had died because the night staff couldn't cope, something might actually be done to remedy the situation.

The fact is, though, that I know we never will; and what's more horrible still is that They know that too. It's hard to leave innocent people to suffer the consequences of poor policy and, on the whole, doctors are a kindly bunch. And so I'll continue to start early and stay late. And I'll continue to be fatigued. Chronically fatigued. Except, unlike those whinge-bags with the syndrome, nobody will ever give me a nice medical diagnosis and put me out to pasture, where I swear I'd be ever so happy just to chew the grass all day long.

Concrete Boots

2006-01-17T21:10:00.000Z

I was once a barman. I liked being a barman for numerous reasons, one of which was the fact that you weren't expected to know everything about being a barman from the moment you walked in. There was a nice little intro to the ins and outs of it all: how the till works, how to change a barrel, how to pour the spirits. If somebody asks for a lager top (and there really is no excuse for doing so I must say!) and you give them a pint of lemonade with a splash of Foster's then who gives a fuck! Your concoction goes down the drain, somebody explains how you make it properly and, best of all, nobody's going to get killed over it.

Medicine, alas, is the polar opposite. With medicine you go in at the deep end. As a junior, every six months you will swap jobs. Just when you've finally got to grips with the nuts and bolts of your job, it's time to up sticks and fuck off to a whole new speciality that you know nothing about. Except, this time, there is no nice introduction, no explanation and no instructions. This time, from the moment you walk through the door, you're expected to know it all. It all.

And that's why today I nearly killed somebody.

As you all know I was recently elevated to the exhalted status of an SHO in neurofuckedology. Today a fat young girl rolled up (quite literally some might say) with 'terrible headaches and suspicious eyes'. The latter were suspicious not because they were warily eyeing up anyone who might potentially steal her pork pie, but because the optician had noticed that the nerves at the back that allow us to see were both very swollen. She had papilloedema and see needed an urgent MRI and a needle shoved in her back to see what was going on in her spinal fluid. Problem was she wasn't the only one that needed stuff doing. There was that bird whose spinal cord is rotting away and can barely breathe, the chap who can't walk properly anymore, and this lass who now needs detailed instructions to do what she's always done without a second thought previously. They all needed needles shoved in their back, and before 4pm when the neuropathologist goes home. Then there's that woman who's bleeding from her bowel and needs a telescope test. Plus all the daily crap for the more-stable others. Shit. Where to start? What to do?

No great surprise then that I found myself rushing at 3:30pm to do the lumbar puncture on the fat chick with the weird eyes. "You get the lumbar puncture quick and I'll go see the patient downstairs.", said my reg. In my rush to beat the clock, I completely forgot why I was doing the test in the first place. I forgot her fucked-up eyes suggested raised pressure in her skull. I forgot that if you stick a needle in somebody's back who has raised pressure in their head then the resulting gradient means their brains are sucked down and forced through the hole at the base of the skull. Crushing your brain through the bottom of you skull is known as coning and is, alas, not generally compatible with life. Indeed I forgot all of this as I pierced her leptomeninges and saw with a smile the crystal-clear spinal fluid that I so desired. I remembered all of this in a blood-curdling flash as the fluid shot up the pressure guage and overflowed the top of it. Fuck, high pressure! Oh fuck, the MRI! The M-R-fucking-I! I'd forgotten to check if there were any big masses in her head on the MRI - if there were then she's going to cone for sure. I finished the procedure in a sickly sweat. I must have asked her about 20 times in the few minutes t lasted if she still felt OK. Nobody had told me to check the MRI but I knew that was no excuse. In fact, nobody told me anything about lumbar punctures at all - I was just expected to do them. Yet, if she died, I would be to blame. The law agrees too. It is an established precedent that, from the minute you start any new job, you are expected to know everything about that job. The fact that you are some naif neophyte is no excuse in the cold eyes of the law. According to the Bolam test, the standard of care expected of professionals is judged by comparing with those skilled in the particular speciality in question. However, the experience of individual health professionals may differ significantly: a newly-appointed SHO in a speciality may have no prior experience of that area. Should he then be judged against the highest standard expected of that post or his own qualifications and experience? The law is clear: just as the learner driver has the same level of responsibility as the qualified driver so the newly-appointed SHO has the same level of responsibilty as his more experienced seniors. Now there's the concrete boots in it all for when you fall off the side of the bridge. If you're drowning because nobody bothered to tell you the fence was missing, don't expect the law to pull you out..

The girl did not cone and die, thank the Lord. There were no masses - she probably just has benign intercranial hypertension - but that doesn't make it any less scary. Every day doctors do things that they don't know how to properly because that's just what you do in medicine. It's the same as any other job, once you've made a few mistakes, you quickly learn what and what not to do. Except that it's not the same as any other job. Unlike the bastardised lager top, a mistake in medicine might just end up getting somebody killed, and yourself thrown in jail to boot.

Speaking Freely

2006-01-13T19:22:00.000Z

You may have noticed that I am a relatively frequent (ab)user of the word 'cunt'. There are at least two reasons for this. I happen to think that swearing is a useful tool in that it adds colour to language by expressing emotion, which is otherwise nigh on impossible to convey. I also happen to think that that good old staple swearword, 'fuck', is on its last legs. In an age when I can read an entire article on the word in my daily newspaper without having to shy away from the old dear sitting next to me on the tube, I can't help but think that somehow it's lost it's magic. Where's that oomf, that zzzing, that kapow!? Cunt, on the otherhand...well...let's just say that cunt is soooooo the new fuck.

You will forgive me, therefore, if I combine two old favourites of mine in the following sentence: Fred Phelps is a cunt! The holy and merciful Fred is also a kind of blogger. His wonderful blog can be found here. Let nobody say Fred doesn't make an effort to keep his blog up to date. Any fag haters out there might wish to review the current list of forth-coming pickets advertised:

1) Funeral of Army Spc. Marcelino R. Corniel
2) Miners Memorial Service
3) Funeral of Marine Cpl. Brett Lundstrom

So, family fun to be had by all there then! I might not be a great fan of war, but can you imagine going to mourn a family member lost in conflict (whether justified or not) and having to deal with Fred and his bunch of dimwit cretins as unwanted guests. What extraordinary wankers to take their grievences with society to a funeral! These people are after one thing and one thing alone: press coverage. They are not even human - let alone religious - in the way they deal with other people's suffering. "They turned America, over to the Fags; they're coming home, in body bags. " writes Phelps. Wordsworth eat your heart out.

It plays on my mind because I am a great believer in free speech and opponent of the limitation of liberty by law. Fred Phelps' incendiary nonsense seems at first glance to be calling out for a banning. It's inaccurate, inhumane, disgusting and hateful. Yet I think it would be a terrible mistake to try and legislate against it. Much like the new religious hatred bill, it would set a very dangerous precedent. In sheilding ideas under the umberella of the law, we protect them from legitimate scrutiny and criticism and provide them with a safe environment in which they might easily grow out of control. It has long been the case that any disagreement with Israel's policies in the occupied territories has been met with cries of antisemitism. This is a patently ludicrous but unfortunately often very effective form of defence. More recently, the chairman of the Commission for Racial Equality, Trevor Philips, was accused of Islamophobia because he had the temerity to appeal to Muslim leaders to reiterate their opposition to terrorism. Religion is only an idea, albeit a very powerful one. It has no special status that demands it must be handled with kidgloves, let alone afforded legal protection. As David Hume was wont to say:

'We may observe, that, in all ages of the world, priests have been enemies to liberty; and it is certain, that this steady conduct of theirs must have been founded on fixed reasons of interest and ambition. Liberty of thinking, and of expressing our thoughts, is always fatal to priestly power, and to those pious frauds, on which it is commonly founded.'

I will not, therefore, be calling for the removal of Freddy's opinions from the Internet. I think he is a good reminder of how far we have come; and how far we have to go. I would prefer instead to call for the removal of any law that suppresses free speech. The separation of state and religion must be maintained at all costs. As an aside, anybody following the recent posts of NHS Blog Doctor will have noted the difficulties that a certain somebody's a-little-too-free speech got them into. I did think it was unfortunate that an opinion could not be stated without recourse to a disciplinary body, especially one as sinister as the Fitness to Practice committee.

Jammy Bastard

2006-01-12T21:23:00.000Z

Some days the most unlikely things happen.

Today was one such day; for today I passed my Part 2s.

Extraordinary

(Fade out to Dreams by Gabrielle...)

A Beautiful Mind

2006-01-11T19:15:00.000Z

I have always been a little saddened by the dearth of talent amid the medics. At the beginning of each new job I arrive bright-eyed and bushy-tailed to meet my new co-workers. In the preceding days I've dreamt of Ryan Philippe or Alex Zane look-alikes that I can drool over at our Sodhexo luncheons. The reality is inevitably heartbreaking. The vast majority of doctors are, sadly, minging weirdos.

The Young Professor is one of our registrars. He lives with his mother. I could stop there...but I won't. He wears tweed suits that, combined with his unruly, grey, wavey hair, makes him look far older than he actually is. He flits about the ward like a manic dandy. He speaks with such pressure that he trips over his own words and degenerates into a frustrated stutter. The slightest problem might sent him into a frenzy of twitching and eye-screwing as he reprimands anyone and everybody for their preceived mismanagement. Worst of all, he never, ever leaves the bloody hospital: he's in early; he leaves last; he even came in on Christmas day when he was supposed to be off! Don't get me wrong: he's one of my favourites - the eccentrics always are - but there's no getting away from it; the boy sure is bizarre!

How on Earth I am supposed to climb the career ladder when people like The Young Professor are already clinging on to the higher wrungs? Yesterday my own reg suggested I start a research project and my heart sank. I don't want to stay behind late and work on some pointless research whose only goal is to feather my CV; I want to go out and dance and drink before I'm too old to do so without consistuting a repulsive spectacle. Yet, on the other hand, I do want to progress and I do like neurology so I know I probably should. Sometimes I wish I were a barman or a shop assisstent who never thought about work again as soon as they walked out of the door. Instead, I'm writing this to put off making my presentation for the Grand Round on Friday. At the same, in the back of my mind, there is the ever-present, gnawing guilt that stems from having forgotten to do something for a patient today. It's like you never leave work, like it never stops, like you're always on call. In the words of a great philosopher: I want to break free!

From Social Chasers to Chasing Socials

2006-01-09T17:44:00.000Z

Today was a good day. The foundations for my unexpected joie de vivre were in fact laid last night during a little jaunt to the cinema to catch the brand-new must-see, Brokeback Mountain. This was a rare pleasure on at least three counts: firstly because it afforded me the opportunity of seeing Dear Jake Gyllenhaal as a needy, closetted gayer begging for man-love, which, strangely enough, is much as I've always imagined him in my dreams; secondly, the man in front of me appeared to have the misfortune of suffering from microcephaly which allowed me to slouch down and still see all of the screen; and, finally, because the whole affair had the undeniable air of an organised Butlin's coach trip right in the middle of London town. From the moment of their arrival it was evident that this film had had a particular appeal for the audience of an alternative persuasion. The marks of the beast were everywhere to be seen: a new-wave haircut or a couple of belt-chains here; a leather Lonsdale satchell or a limp-wrist there. Then, once the whole fandango was over and the tears had been dried, almost the entire cinema promptly got up, swiveled on their Gucci heals, and minced off en masse to That Bar for the first New Week's Eve celebration of the year. The Pink Psychiatrist and I also went along...but only to study the social phenomenology, naturally.

It could have all gone horribly wrong; all that studying of social phenomenology left me feeling a touch fatigued this morning, after all. Thankfully, I was saved by the fact that my job consists of little more than 'chasing' and can therefore be almost entirely conducted from the end of the mess telephone with a sausage roll in one hand and a triple espresso in the other. (I am in the process of finding out the patient's bedside telephone numbers so I will never have to enter the ward again.) 'Chasing stuff' is one of those things that has been invented to take up junior doctors time so that they have something to pay us for. A typical chasing scenario might be as follows. Say I'm a registrar or consultant and I want a CT scan. My junior diligently orders the scan but, because of demand, there is a waiting list for it of, say, on average, three days. Yet, on the wardround the very next day I will feel compelled to ask them to 'chase CT', predominantly because otherwise there would be nothing to write in the plan bit for that day. The junior is then compelled to phone the CT department to ask why the CT scan has not yet been done. It has not been done, of course, because there are other people who have been waiting longer. Simple and sensible. However, by the time the junior has actually got through to switch board, then spoken to the whole department before finding the right person to ask, and finally debated the whole situation for a while to no avail, it is quite possible to have wasted a good hour. It appears to be a prerequisite of seniority in medicine that you hold the delusional believe that a test chased is a test done faster. Only the juniors really know that chasing achieves sweet F A and they're not going to tell because then they'd be out of a job! Besides, there is no end to the things or people that can be chased. Chase CXR. Chase bloods! Chase social services!! Chase next of kin!! Chase old notes!!! Chase neurology review!!! Chase your tail round and round and round and round...

Arbeit Macht Frei!

2006-01-06T19:44:00.000Z

Yesterday I returned to work after a month of blissful freedom. So traumatic was this transition that I fell ill the night before with a clutch of psychosomatically-induced symptoms, including fever, all-over body pains and an intensely sore throat. Alternatively, this might well have been tonsilitis brought on by suppressing my immune system with as much time on the lash as was humanly possible before starting back. Either way it's work's fault.

I am now officially a SHO in Care of the Neurofucked, albeit a slightly ill one. Since my hallowed instituition is a tertiary centre, everybody is intensely clever. So clever, in fact, that if they hear hooves then they just know it's gotta be a zebra. Being so terribly clever, we only deal with the really big cases. To get through our doors, it's no good just being neurofucked - no, let the plebs in the other hospitals deal with that. Baby, if you wanna hang with the wunderkinder then you gotta get yourself neurodoublefucked, and preferably in a confusing way. We got lapdancers that still groove away in their encephalitic comas; we got stiffmen that shuffle about like mannequins; and we got peeps who went to bed normal and woke up tetraplegic by the dozen. Furrowed brows are very much the order of the day.

Being a tertiary centre, we also only deal with the biggest egos. It ain't no good being a genius if everybody else doesn't know it. The consultant ward-round is the battlefield on which the big beasts of Neurofuckedology lock horns in a grand game of one-up-manship. The SHO reads out the details of some poor neurofucked's case; the beasts comtemplate a moment; then the games begin.

"Well, it's Whipple's encephalitis as sure as I'm the world's expert on it!"

"Really, John! This is as much a case of Whipple's encephalitis as I am a prima ballerina!".

"Oh come on, Thomas, it's obviously tuleraemia! And what's all this nonsense about West Nile Fever anyway".

"Look chaps, I think it's pretty clear here that what we're dealing with is a cocaine-induced vasculitis super-imposed on a rabies encephalitis with an added akinetic-rigid component - I mean what the hell else could it be, you blithering idiots!"

Of course, nothing is actually decided about what to do next, but at least we all know who is the cleverest neurobeast of all by who came up with the most far-out and unlikey diagnosis. Yes...I definately think I'm gonna like this job.

Euthanasia And The Death Penalty

2006-01-03T18:12:00.000Z

In the previous post I set out the reason's why I am in favour of permitting euthanasia in select circumstances. As well as being in favour of euthansia, I am against the death penalty. It has been pointed out that at first glance this may appear inconsistent and hypocritical. I, however, do not believe that this is inconsistent at all, and this is why...

The death penalty is the most extreme act of revenge that the state is authorised to use in the name of justice. It has been abolished in the majority of democratic countries in Europe and Latin America; it is retained by the U.S., most Asian democracies and nearly all totalitarian regimes. The crimes for which the death penalty may be invoked range from murder, via drug traffiking all the way down to theft. Amnesty International states that, officially, around 3,797 people are were executed in 2004 but, in reality, the number is likely to be far higher. In March 2004 a delegate at the National People's Congress said that "nearly 10,000" people are executed per year in China.

It's supporters argue that it acts as a deterrent and, indeed, one chap pointed out on NHS Blog Doctor's site that 'the UK's homicide rate has trebled since its abolition. Meaning that over 5,000 largely innocent people have been slain who might not have been, had we retained that ultimate deterrent.' Though it is true that murder rates are around three times greater now than during the during the period, it is a logical fallacy of the post hoc ergo propter hoc variety to say that this is due to the abolition of the death penalty. There are any number of reasons why the murder rate may have risen that would be completely unaffected by the possibility of a death sentence: there are more fire arms in circulation; society is less homogenous and riven by more tension; there is a widening gap between the rich and poor; there are better detection and conviction rates for murder. Correlation is not causation. Besides, murder rates are no lower in countries that retain the death penalty than they are in those which have abolished it and, indeed, in the USA, the much-vaunted drop in homocide in the previous ten years was proportionally greater in in those states which do not use the death penalty.

Anyway, the main point really is this. Many oppose the death penalty on the grounds of the sanctity of life. They state that it is always wrong to end life because life is a something scared. The basis of this belief is usually religious or deontological. The latter is best exemplified by Kant who said that every human being should be treated as an end in themselves, as opposed to a means to an end. Every person is a basic good and must be valued as such. It is, therefore, an absolute wrong - ie. it is wrong regardless of the circumstances - to kill any other human being. If this were the basis on which I opposed the death penalty then, yes, it would be incompatible with support of euthanasia; but this is not the reason. I am not religious so the 'gift of God' argument carries little weight with me. Moreover, I don't even believe that it is always wrong to kill somebody. If, for instance, I were on a plane that had been hijacked by a terrorist who was threatening to crash the plane and kill everyone on board, I wouldn't hesitated to try and kill him first with whatever I had to hand. Yet, even he, the terrorist, is an end in himself according to Kant and it is always wrong to kill him regardless of what he does. That's part of the reason that I think Kant is wrong and why I do not think anybody has an absolute right to life.

Instead, the reason that I oppose the death penalty is purely pragmatic. The justice system is not perfect and it never will be. Neither here nor anywhere else in the world can we be assured that there will never be a wrongful conviction. Even the fact the State might remove somebody's freedom by imprisonning them in error is terrifying enough, but at least in that case there is a chance that if new evidence emerges the ruling can be overturned and the person set free. Once you have killed somebody, however, there is nothing that can be done except a posthumous pardon and that is no recompense to the victim, only perhaps to their relatives and even then a pretty poor one. Many of the accused cannot even afford legal representation and end up being represented by court-appointed attorneys whose credentials are sometimes weak. The odds are stacked in favour of the prosecution from the outset. Since 1973, some 122 people in 25 US states have apparently been released from death row with evidence of their innocence. It is the falliability of the justice system that prevents me even considering the death penalty - not the sanctity or right to life - and that is why I think it is perfectly compatible with supporting euthanasia.

Right, that's the end of that... back to away-gays and slugs from now on for me!

What's So Bad About Euthanasia?

2006-01-03T14:51:00.000Z

I was recently pointed in the direction of another disenchanted doctor’s blog – there does seem to be an awful lot of them, doesn’t there? – that provided some very interesting reading. It seems while I’m jabbering on about away-gays and not calling my friends, other people are pondering far deeper issues surrounding the ethics of the death penalty and euthanasia. There were two main points that interested me. Firstly, is it wrong for doctors to be involved in the business of ending life and, secondly, is it inconsistent to support euthanasia and be against the death penalty?

As regards euthanasia/killing people (the exact terminology matters little), the NHS blog doctor is opposed on the basis, it would seem, that he does not think that medicine should be involved in ending life at all. Medicine may be used to prolong, but not curtail, existence. The Hippocratic Oath is trotted out: presumably for the line stating “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” There is nothing wrong with this point of view and I certainly think, on an issue as difficult as this one, every individual doctor should be allowed to fall on either side of the ethical fence without any reproach or criticism. I myself fall in favour of euthanasia and so I thought I might try and set out why here. I suppose the first thing to say is that I do not think the Hippocratic Oath has any relevance at all. As was pointed out by another blogger, the principle most associated with the Oath – primum non nocere – does not actually form any part of it and many of those exhortations that do are inappropriate today, eg. not taking up the knife, not performing an abortion etc.. I did not swear the Hippocratic oath; I do not feel myself bound in any way, shape or form by such an anachronistic document; and I think it is a little odd that it is apparently still administered to graduates in the US (or so I was told). This frees me from any criticism based on my not observing the Oath’s ban on administering deadly drugs at least. So there.

Firstly I suppose I should set out in what circumstances and in what form I would permit euthanasia. Since the termination of somebody’s life is an irreversible and extreme measure, the circumstances in which it could be used would have to be appropriately grave. The kind of illnesses for which I would permit euthanasia would have to be intractable, imminently terminal (say 6 months or so) and to cause (or be likely to cause in the near future) intolerable suffering. Palliative care must be maximised prior to the patient’s request being considered. The patient must make at least two requests for euthanasia separated by at least two weeks; they must be able to change their mind at any point; they must be assessed by a psychiatrist to exclude any psychopathology or impairment of reason which might jeopardise their competency to make the decision; and most importantly they must be under no external pressure to decide to die. I realise that the last point is a tricky one since it is always extremely difficult to ensure that people are free from coercion and, as people don’t shy away from dumping granny in A&E for Christmas, there is the worry that some might seek a more permanent solution to the annoying old baggage. It is also sometimes said that doctors would themselves be under pressure to push the idea of euthanasia for patients who require expensive and/or constant medical care and because of the pressure to free up limited beds. However, such arguments are in my opinion little more than scaremongering tactics. Surely few people are so morally bankrupt that they would seek to bring about somebody’s death against their wishes – especially for the sake of cost. Besides, those that would, such as dear Dr Shipman and Nurse Allen, will not be stopped by euthanasia remaining criminal any more than they would be protected by its legalisation. The same kind of basis seems to me to form the basis of the slippery slope argument much beloved of the Daily Fascist…er sorry I mean Daily Mail. In a nutshell, it is suggested that once we have accepted ending life in no matter how tightly controlled the circumstances, it’s only a small hop, skip and a jump until before we’re hooking granny up to the potassium chloride because she’s failed to get over her tickly cough in good time. Obviously I parody but the idea is essentially the same: human beings are so devoid of any morality that they would not flinch at ending people’s lives at the drop of a hat. Firstly, the law would make sure the application of euthanasia could not be expanded without vigorous and lengthy debate beforehand, so I very much doubt we’re going to ‘slip’ anywhere in a hurry. Secondly, given the enormous sense of queasiness people feel about accepting euthanasia even in the narrowest of circumstances, it is more likely that the euthanasia – like abortion – would suffer constant attempts to recriminalise rather than liberalise it.

So that’s who I might allow to choose to die; now why I would allow them to choose to die. I suppose the least intellectually rigorous but most important reason for me is that I feel it is right to do so. Most people accept that when an animal is beyond help and its remain life is or is almost certainly going to be predominated by suffering that it is merciful and right to have it destroyed. Human beings are merely animals too, and an unfortunate few experience intractable illnesses which cause them extreme suffering and obliterate their quality of life. In the first example we are imposing our view of what is best on the animal without any moral qualms, whilst in the second the human being would have to actively express a desire to die that is constant over time and then meet very rigorous criteria regarding their condition. Yet despite this, we still would not permit them this release. How then can it possibly be right to allow people to suffer when we would not permit any other animal to do the same? I have my own personal fear of diseases that paralyse the body whilst leaving the mind intact – motor neurone disease is perhaps the exemple par excellance here. Whilst I cannot possibly know what I would really think unless I were actually to be in that situation (which is why I hope this next statement will remain forever hypothetical), I feel very strongly that I would not wish to progress to the point where I was completely reliant on others for everything yet completely sound of mind. Were euthanasia still not available and were I really in this situation, I think it would be intolerable for me and I would have to kill myself. Why should I be criminalised if I had made a competent decision based on all the information and chosen that I did not wish to continue?

Then there is the issue of returning control of their lives to those who want it. Having seen a fair few terminal patients in my nine months of Oncology (yes, I know, it’s not long but it’s still a lot of dying but compus mentus people), I realise two things. Firstly, the vast majority of terminal patients do not wish to speed on their death but instead extend their lives by whatever means possible. I once had a patient with breast cancer complicated by massive lung and brain mets that was adamant that she be resuscitated in the event of an in-hospital arrest. Hence, I cannot imagine that people would be leaping like lemmings into euthanasia without their circumstances being unbearable. Secondly, those that do wish to shorten the dying process usually have a pretty good reason for wanting this. People often talk of pain and how proper use of analgesics should mean nobody has an unpleasant death. In respect to this, I have two things to say. Not all pain is responsive to analgesia, even at doses which essentially render the patient almost comatose. Some pain responds to absolutely nothing – not morphine, not nerve blocks, not antiepileptics, not nothing! Moreover, not all suffering is about physical pain. Mental suffering engendered by the loss of function and independence consequent on illness can be equally as, if not more, distressing than physical suffering and is far more resistant to treatment. Thus, if a patient is sound of mind and makes a well-reasoned request to end their lives, do we not then as doctors merely respect the patient’s autonomy if we choose to help them to do so? Is this not in fact one of our core duties? Until you are actually dead, you are by definition alive: dying is thus just another part of living. We expect and prize the liberty to determine every other aspect of out lives – why not dying?

Phew…I think that will have to do for the moment. I hadn’t quite intended to write so much. I’ll have to finish off explaining why I think support for euthanasia is perfectly compatible with opposition to the death penalty in a subsequent instalment. Goodness, what a cliff-hanger!

Epiphany

2005-12-26T18:35:00.000Z

It has been nice to be home. There is nothing here for me now apart from my parents, but the whole place has a familiarity that I find deeply comforting. And, perhaps because I have little else to do, these little sojourns up North afford me some much needed thinking time.

It has become apparent to me recently that I've become increasingly shoddy at maintaining my relationships with people. Slowly but surely I've got worse. I started making less and less effort to arrange to meet up with people. I never phone anybody - not my friends, not my family, not the Australian. I read text messages people send and, unable to find the energy to reply immediately, put it off until I end up forgetting to do so altogether, which must appear unforgivably rude. I have relied too heavily on the goodwill of others in not abandoning me completely as a lost cause and can only be thankful that this has been forthcoming. So far, that is.

Then I saw the light. An awakening, a revelation, an epiphany. Not of the religious sort, but of a personal nature. It is too private to go into the actual substance of it, but, as with any epiphany, it is not the actual sign that is important but the significance it carries. Like the Spirit of Christmas Future, that experience painted in an instant an all-too-clear picture of what would come if I continued in that vein. Undoubtedly I would get more and more lazy and the goodwill and patience of others cannot be stretched indefinately. Eventually people would give up - quite rightly - on such a one-sided relationship and I would be left all on my own with nobody to blame but myself. Alone...and a slug.

And so like Ebeneezer himself, I did thank the Lord that all was not yet lost and did declare that changes there must be and changes there will be! Let's just hope I can succeed in turning words into actions. After all, an epiphany is for life not just for Christmas.

A Christmas Carol

2005-12-25T16:18:00.000Z

Happy Christmas to one and all.

Awwwwwwwww.

Seriously though.

The Slugs of Marrakech

2005-12-21T18:14:00.000Z

One new thing that I learned while holidaying is that Morocco is soooooo the new Tangier. For those who blissfully unaware of what the old Tangier was, allow me to educate: Tangier was none other than the Dark Continent's premier gay knocking shop. The playground of the aging, late twentieth-centuary Eurogays who had learned that, though money might not be able to buy you love, it can certainly buy you a good seeing to. And what to do when you've worked your through all the local renters and most of your retirement funds? Simple - hop over to Tangier and get yourself something a little exotic and a lot cheap.

All this I learned from a book, you'll be glad to know. The very same book that told me that Marrakech - the aptly named Pink City - had succeeded in establishing itself as the new whorehouse of Africa for the twenty-first-centuary away-gay. Young colts are attracted from all over the continent to ply their trade and make their fortune off the back off some aged Euro-queen (no pun intended). Naturally, I was interested; and keen to learn just how close to the surface this seedy underworld really was.

So, what did I find? Well, an hideous variety of common-garden Slugs for starters. They were everywhere to be seen, slipping across the Jemaa El Fnaa or up the Avenue Mohammed V, alone and on edge. Typically they were around 40-60 years old, outrageously coiffed (mullets and blond hilights abounded), and horribly camp. In one of the more notorious clubs, there was even a Timmy Mallet multicoloured silk shirt combined with skullet on show (a skullet is the hairstyle of man who previously had a mullet but has now gone bald on top leaving only the straggly turbospoiler at the back).

Then there was the actual renters. With the gaydar switched to scan, these shone like stars in the Islamic darkness of Marrakech. Those in the Jemaa El Fnaa tended to go for the slightly-too-long stare technique or a sly wink if they were feeling confident. Another breed stood out for their attire. Immaculately dressed in the latest European fashions with pair of ubercool sunglasses permanently perched on their pretty preened heads, they were mainly to be found loitering around Place de la Liberté or, in one case, standing on the roadside near the most fashionable bar in town. One low-class prozzy drunkenly made a grab for the arse in way of a come on. All very amusing.

I couldn't help but feeling sorry for the little tikes. Not because they were prozzies - I'm sure it's a fairly lucrative game for some of them - but because they had to sleep with sweaty, leering old Euro slugs to earn their crust. Personnally, I think I'd rather see if there was any work going down the sewers before I considered that!

The Spirit Of Christmas Past

2005-12-20T02:04:00.000Z

Just a quick 'un to prove I'm not dead....

Yeah! I'm back from my holiday in Marrakesh!

Marrakesh. Now there's a bit of fun. Kinda medaevial market town without the teeth. I have to say, for the cheap gourmand, it's heaven. You can have all the ponciness of French haute cuisine without the price. And a few Morracan prozzimodos flung in for good luck.

I note from the responses to my previous post that Andy keeps a keen enough eye on his website to ken who's been linking to it. To be honest, I think he has a fair enough point: he deserves to know who posted his link up on the web as an example of what he would not like to become. Andy is diametrically opposed to my ideal in life: he is a very effective doctor - the kind of doctor you'd want to see if you'd been in a car crash and you were bleeding out. He is not, however, the guy I'd probably want to see had I just been told that my CT scan showed a 'funny looking grey bit' that nobody was yet prepared to explain. As far as I'm concerned, Andy seems like one of those medics who would be far better at communicating with the consultants than with the patients. I could, of course, be wrong...but really how likely is that?!

Cortisol Overload

2005-12-10T19:10:00.000Z

I'm drinking red wine to prevent myself having a heart attack (apparently it doesn't work, by the way). I have just spent the entire day on a train. Yes, the entire day. Just to collect my passport from the ever-so-conveniently located passport office in NEWPORT, SOUTH WALES! 5 hours round-trip for 10 minutes spent in the passport office. It was exhausting.

I subjected myself to this because I desperately want to go away. And I've now just spent 3 hours on Expedia/Last minute/Opodo trying to book a cunting holiday somewhere vaguely interesting and not ice-cold to absolutely no avail because none of the cuntish airlines do e-tickets! Sweet Jesus H. Christ, how can I book a paperless ticket to go to Wales on the backwards bloody railway system 6 hours before I travel but not to take a flight in 2 days time? How arcane are paper-cunting-tickets!

Anyway, I'm going to lie down in a darkened room with a wet flannel on my brow for an hour or two before I burst an artery or something. Then I'm going to get wrecked.

PS: Don't you think it's a little freaky that Riaz's bio-thing is written in the 3rd person? Kinda schizo, really.

PPS: Nein, Herr D&C. A different Ice Queen, but from the same mould.

Cuntification

2005-12-09T14:32:00.000Z

To understand the deleterious effects of medicine on the soul, please find time to review the toe-curling website of Dr Beggs, a fellow graduate of our year, at www.andrewbeggs.org.

Train Crash

2005-12-09T14:03:00.000Z

The exam is over. Thank the Lord for that. Unfortunately, I was accidentally trapped on a table full of post-exam dissectors in the pub after the event and so was forced to relive most of paper three in minute detail. It turns out great minds did not think alike and I feel I can look forward to a replay next year.

On a brighter note, I feel absolutely wretched this morning (nice word, wretched - not used enough). Combined with the fact I can't remember how I got home or when, I think it's safe to presume that I had a good time last night, though possibly a fairly rapid one. I now fully intend to laze about the house, drink tea and generally do absolutely fuck all until I go ice skating tonight, which, I'm sure, will be simply charming.

Cry Baby

2005-12-06T14:43:00.000Z

I'm very, very, very SAD!

because...

1) I slept all day yesterday after my nights and went out clubbing until 3am last night and now have woken up feeling slightly rough with only half a day before the exam. So much for my two days of heavy revision. The exam is a write-off and a nine-hour long one at that!

2) I phoned the passport office today and I'm not going to get my passport in time for my holiday next week. I thought a month and a half would be easy enough time to get the thing, but no, apparently not. So now I'll have to wait for another 6 months before I get any time off to go anywhere.

No wonder I'm feeling all Wade Walker.

De Profundis.

2005-12-05T02:30:00.000Z

Firstly, hello to Vegas. I'm not entirely sure who you are either but I have my theories.

It's 2:30AM and all is reasonably quiet for the moment in the wretched hell hole that is A&E. I really should try and grab some kip so that I can do some work tomorrow but I'm feeling guilty that the ward SHO and HO are both absent from the mess, suggesting a busyness which I just can't bring myself to help them with. Thus, as a form of penence for my cuntishness, I have decided that I will deny myself the comforts of my bed to sit and type instead.

I have been periodically seized by paroxysms of fear recently at the thought of getting all 'middle aged'. I'm still not entirely sure precisely when 'middle aged' begins but I fear it might be sometime soon. I'm pretty sure when I was 17 I must have thought it started right about now. Once here, however, I've found it more convenient to push the boundry back a little bit...to thirty, say. That only gives me roughly another four years of life before my world begins to slowly crumble around me and I sink into depression and apathy. And what will be the trigger for this change? Simple: the transition of others and my lack thereof.

By transition I mean the movement between different stages in life. Admittedly, these are not set in stone and regression is always a possibility but, by and large, the majority of people seem to move through fairly discernible stages in their lives. So far my friends and I have made our way through a few of them together: we've done infancy; then dependency and education; and now independent and working. The next big transition fro my friends will be into marriage and then children. These are not really possibilities for me (unless I suddenly decide that getting myself a trophy wife and living the lie sounds like a good idea). And there wouldn't even seem to be anything to substitute in its place. So, what will I do? Continue on with the drinking, the clubbing and the cruising till I get a cardiomyopathy and my heart dilates up to become about as effective as an ASDA carrier bag? End up in A&E as a haggard and broken-down wreck? Well, yes, quite probably. What's worse is that as a gay guy gets older and loses his looks, he becomes an object of pitty in a world that venerates youth and beauty beyond all else. In fact, I sometimes feel that being gay might be a bit like having social progeria. 'Slugs', as we fondly call the older gay, can always be found stuck to the wall of any gay bar, hungrily watching in the midst the throng. They are always there, but seldom noticed. Soon I too will be a player no more; just a passive observer of other people's amusements. Sigh. What's the point in that?

No transition, no advancement... just stagnation.

Outed!

2005-12-04T15:35:00.000Z

I had possibly the most pleasurable on-call ever last night. I saw three patients between 9pm and 1am, then I went to bed, and when I woke up (not even to the sound of my bleep, I might add) it was 7:30am! It was all too much and I must confess to having to bleep myself to make sure the thing hadn't stopped working and there weren't in fact queues of riotous patients waiting to be seen in A&E. It hadn't and there weren't. I'm praying for a repeat tonight but I fear there can be no pleasure without pain and it might be hell on Earth. Yet come what may, I'm determined to stay happy as tonight will be my last shift before my month long holiday starts! Yes, that's right - a whole month over Christmas and New Year. Hurray for the my crazy rotation!

There remains the slight problem of the exam. I'm beginning to wonder if failure might not be so bad a thing. Perhaps it will dispel this destructive idea that I might still just pass it with no revision provided I happen to get lucky because that's what happened with Part 1. Then again, I really don't fancy paying for and sitting it again so I suppose I'll use Monday and Tuesday to do as much last-minute cramming as is possible.

Finally, by some unknown mechanism, which will probably turn out to be really obvious, it would appear The Lost Doctor has somehow managed to find my blog. I had kinda intended to keep it private, though I'm not really sure why. Perhaps because I had copied his white-on-black background and was ashamed of my lack of orginality? Or perhaps not. Anyway, if you do happen to be reading this, don't take it too seriously - it's just a little bit of escapist fun for me!

The Ice Queen Strikes Back

2005-12-03T17:49:00.000Z

What is this? ---------------->

Alas, this is me after a run in with the Ice Queen bitchosaurus of a registrar who made me stay behind late on a 10 hour shift by insisting that I clerk one more patient in the last 20 mins. She only had three fucking patients to be clerked and there were still two SHOs, a HO and herself after I went so it wasn't like they were drowning in referrals. I thought maybe she'd forgotten that I was supposed to go home at 7pm so I tried a little friendly tug at the heart strings by inquiring if she might have a reasonably simple one I could see quickly so I could get off on time (I later realised that said strings were not in fact attached to any heart, but to a cold, dark stone that remained resolutely unmoved by all tugging). There was a moment's pause before she looked up from her list, her naturally miserable face set like marble, and instantly froze me to the spot with her icey reply: as an SHO you should be seeing a patient every 15 mins! "OK.", I said slowly; "you horrible, bastard-faced, cold-hearted, evil bitch!", I thought quickly. Then, just to make sure I knew who was boss, she handed me some 900 year-old patient with "?TIA, decreasing mobility and confusion". A history and full neuro exam on some garrulous old baggage who barely even knows what day of the week it is never mind what's brought her in to hospital - that's just cruel!

No wonder I ended up having to be stretched out of the hospital at 7:40pm in the state shown above: worked to the bone and frozen to the core by the evil Ice Queen registrar.

Tragedy!

2005-11-29T18:40:00.000Z

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

2005-11-29T14:13:00.000Z

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

2005-11-23T18:00:00.000Z

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!

2005-11-22T15:55:00.000Z

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

2005-11-15T10:04:00.000Z

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

2005-11-09T18:55:00.000Z

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

2005-11-08T18:30:00.000Z

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

2005-11-07T19:40:00.000Z

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...

2005-11-07T12:54:00.000Z

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....

2005-11-05T14:41:00.000Z

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

2005-11-04T19:03:00.000Z

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!

2005-11-02T20:20:00.000Z

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

2005-11-01T14:17:00.000Z

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.