Preparations

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

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

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

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

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

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

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

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

Aiding and Abetting

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

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

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

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

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

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

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

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

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

D'Oh!

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

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

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

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

Of Another World

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

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

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

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

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?

al-sistaniexecutionhomophobiamurdergayiraq

A Little Light Relief

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...

...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

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

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

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

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

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

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

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?)

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

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?iraqhomophobiagayal-sistanimurder

Music To My Ears

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

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. polandhomophobiagayprotest

Hell in a Handcart

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

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

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.