Death In All Its Many Forms

I see dead people: lots of them. Primarily in my job as a doctor in a geriatric ward, I have issued dozens of death certificates. For the vast majority of these patients death came after "a good innings", and for a lot of these people death came as a blessed relief from pain, or other distressing symptoms. For most folk, death is something they rarely come across, and it remains very much a taboo subject for much of the UK population, even in the 21st Century. For me, and the doctors and nurses I work with, death is very much part of life. Some might see this response (or lack of it) to death as a form of desensitisation, and I certainly think my response to my father's death was influenced, and probably blunted, by my medical experience.

Today I'm on call for the Police. At 17.00, when I was thinking of going for a curry, I was asked to go and examine a 25 year old man who had put the barrel of a rifle in his mouth and pulled the trigger. He had left a suicide note. I can still see his face.

If that sort of death ever stops touching me I should probably "hang up my spurs".

It's not been a good week...

I have been fortunate, up till now, to have had very good health. I've had very little time off work. This week one of my partners is on holiday, so being ill was a particularly bad idea. There have been a lot of nasty viral illnesses around this Winter and I was congratulating myself on avoiding them all when, at the weekend, I had a slightly runny nose and a mild sore throat. On Monday morning I felt pretty normal. "Clever old me" I thought, "to shrug that little sucker off so easily!"

By mid-afternoon on Monday I had virtually no voice. I've never had significant hoarseness before, and I didn't realise how tiring it is to try and conduct a consultation when you are having to make a supreme effort to squeeze the words out. I was mildly amused to note, as I have observed before, that the patients I saw either didn't notice I was unwell or were too polite to comment on it! I decided to take Tuesday off so that I could make a concerted effort to fight off the virus.

I struggled through yesterday at work, but last night felt my left eye was a bit uncomfortable. This morning I awake with pretty florid acute conjunctivitis---something else I've never had before!

I have always felt that doctors empathise much better with patients if they have experienced the patient's symptoms themselves, but, if anyone's listening up there, I've had enough for one week thanks!

Simply Alsome

I never cease to be amazed at the range of things people, particularly women, talk about---often in surprisingly public places. I wonder if you, like me, love the experience of coming into a room and catching the bizarre-sounding tail end of a conversation? Isn't it a joy to mull over in your mind what the participants might have been discussing?

If I've got you sussed, Overheard in the Office is the website for you. Although the flavour is distinctly American, many of the themes covered are basically universal: fetishes, penis size, and whether or not to start a career as a stripper (to name but a few). The most popular section is a riot, although I'm sure that first one was made up!

Alsome, indeed!

Unsung Heroes

Many folk, myself included, find this little Dilbert clip hilarious. The question is "Why?" I've always been interested in humour and the reasons why certain people find certain things funny. It seems to me that the main reason people find this video humorous relates to the surprisingly low social standing that engineers have compared to other professions.

This chart shows the IQ ranges for a wide variety of occupations. As a medic, I smugly noted that "Medical occupations: MD and equivalent" occupy the top slot, but as you can see engineers of various types are not far behind. I don't have the figures to hand, but I suspect that, on a global basis, engineers are paid significantly less than doctors.

Much of the hi tech world that we take for granted---the machines we use, the roads we drive on, the internet we enjoy---owe their existence to engineers of various sorts. So why do we treat these guys as figures of fun? Why is Dilbert's mum so upset that he is destined to join their ranks? Maybe it is something to do with the name? The term "engineer" conjures up an image of rolled-up sleeves and hairy arms covered with machinery oil.

Perhaps engineers need to call themselves something else to try and get the respect from us all that they undoubtedly deserve?

Royksopp - Remind Me

This is a clever little video and the song is quite hypnotic, but I'm not sure what the message is.

Still A Political Football

Patricia Hewitt is an idiot in so many ways. My spirits picked up a little when I heard last year that Gordon Brown was said to favour handing over day-to-day control of the NHS to an independent board - in the same way he gave up control of interest rates to the Bank of England in 1997. At last, I thought, I might work for an organisation that is run by people who have some idea what they are talking about instead of suffering the consequences of being run by feeble-minded politicians who have no experience of the NHS, either as managers or, in many cases, as consumers. In my experience, politicians often have poorly thought-through ideas that seem to be based on gaining short-term popularity through headlines in the tabloid press.

According to this article, however, that plan has fallen out of favour. I note Hewitt's comments about the putative benefits of "competitive pressure" within the NHS, but I would like to see the evidence for such benefits especially outwith major cities, IE in places where the local hospital has no effective competitor.

Hewitt is said to back an NHS constitution, which could cover behaviour expected of NHS patients and people's personal responsibility for their own health. This is another area where political rule falls down. It's not exactly a vote-winner to tell people that they should be more responsible in the use of the service.

It seems Hewitt is likely to go when Brown takes over the helm, but it appears that the poor staff of the NHS will continue to work for a "polical football".

Diminished Responsibility

Diminished Responsibility
Originally uploaded by Son of Groucho.

I have worked as a Police Surgeon for many years. Most of the time the work involves seeing prisoners, usually drug addicts, in the cells, but we also have to see patients who have died unexpectedly, partly to see if there are any suspicious circumstances to the death.

In the early hours of 15th June last year I was asked to visit an address in Dumbarton. An emergency call had been made for an ambulance. The initial gist of the panicked phone call was that an elderly lady had collapsed in her home, but when the crew arrived to find the lady lying dead in her bedroom surrounded by blood with a large hole in her neck they surmised that something might be amiss.

I’ve been to a number of crime scenes over the years, but this was probably the bloodiest. Details of the subsequent court case can be found by clicking on the picture, but the outcome was that the poor woman had been stabbed while she slept by her grandson, who was only 15 years old at the time.

We will probably never know exactly what went on in that house but, on the surface of it, McAlpine stabbed his grandmother after she threatened to “wash her hands of him” if his behaviour didn’t improve! You really wonder what provocation would drive a 15 year old into such a rage that he would stab an elderly woman 23 times.

On the way home in the car this evening I heard how a teenager had been killed in Blackpool by a single stab wound to the chest. We clearly have to convince our young people that carrying knives can lead to tragedy---for all age groups.

Perils of Videoconferencing

Everyone is so busy these days, but there always seems to be a increasing need to have meetings. I've made the point before that I'm not a great fan of these. Maybe technology can come to our aid? With the increasing availability of broadband links and the falling price of webcams, some folk think that videoconferencing is the answer: allowing us all to sit on our backsides even more, but still take part in these invaluable hot-air-generating sessions.

This video makes the point that videoconferencing should be used with care. One point to remember is that just because you can't see your colleagues it doesn't necessarily follow that they can't see you!

Home Alone....Or Not Quite

Wosog has gone with her two sisters and her mother to Barcelona for the holiday weekend (IE from Friday to Monday). Fortunately (?) this is my regular weekend working during the day for the local Out of Hours Service. One of the other GPs who I work with says that this is the start of a slippery slope. His wife once went on an outing to Edinburgh with friends while he was working. She now jets off regularly to various exotic locations while he is soldiering away "Puting Death and Disease to the Sword". Funnily enough, she's a teacher, like Wosog: it's easy to see why females tend to live longer than males!

Gdog is home briefly because she hasn't managed to get a job on Glasgow yet, and she is still working at one of the local supermarkets. I saw her briefly last night, and was surprised to find that she's supposedly staying in tonight (though I'll believe it when I see it). We might actually have some "quality time" together (to use the jargon).

Gsog has just got a job in the same supermarket as Gdog. It's only since he started his job that he seems to have noticed the hours that I work! He describes my hours as "insane", which I suppose compared to his 14 hour working week (over and above school) is a fair description.

All in all, the house seems helluva quiet!

A Life on the Ocean Wave

Just got back from a course in rural Argyll. The course was on intermediate care: a rather vague, but trendy, term that means different things to different people. Basically the principle is that GPs may become more involved in doing things that were traditionally done by secondary care doctors. The hope is that intermediate care may overcome the problems created by increasing centralisation of medical services for the significant slice of the Scottish population that are unfortunate enough (?) not to live on the doorstep of a large teaching hospital. One of the difficulties is deciding exactly which services GPs will be able, and willing, to provide on a long term basis. I thoroughly enjoyed the course, and I will be exploring the subject further.

We had two free evenings, and on the second of these a GP colleague, whom I've known for years took me, and 3 other GPs, out in his yacht which is, I think, around 30 feet long. I've never really appreciated the attraction of sailing, but it was amazing how "away from it all" I felt even 30-60 minutes from casting off. We headed towards Jura and I took some pictures of the sunset as well as the "rib" of the course director, who joined us at one point. We came back in the dark and I was amazed how Patrick, with knowledge of the area going back over 20 years, safely threaded us between fish cages, boys, rocks and small islands on the way back to the marina. Maybe there really is something to this "life on the ocean wave" business!

A Cushy Number

When I was a junior hospital doctor (when dinosaurs roamed the Earth, as Gsog would say) we worked ridiculously long hours, often while distinctly sleep-deprived. You would be involved in medical receiving, clerking in multiple admissions, have about 1 hour's "sleep"; have to take all the blood samples from the patients that you had admitted (phlebotomists hadn't been invented); then present them to the nicely rested consultant on the ward round. Surgical house jobs were not any better, and I well remember almost falling asleep standing up while assisting at an emergency cholecystectomy (gallbladder removal). Although these working conditions were deplorable and in some cases downright dangerous, they certainly made sure you knew what was happening to your patients: primarily because you rarely left them! There was also a definite camaraderie, a "war time spirit", engendered between juniors on the same team.

I was interested to read this article about how beneficial the reduction in junior doctors hours has been, and there is no doubt that, in many ways, it has been A GOOD THING. I think it is true, however, that continuity of care is less good with juniors working a shift system, and I don't think there is the same team spirit that we had in our day.

Old fogeys, like myself, tend to feel that juniors these days have a pretty cushy number compared with what we had in our day, but in general they don't seem any happier than we were!