Celebrating living

I walked slowly down the corridor, my white kitten-heeled sandals click-clicking, keeping time to the musical squeaking of his wheelchair.

Now that Mr Wheels was feeling much better and was able to get about on his own, he had many questions about his current condition and treatment. A few days previously, he had rolled in on a stretcher, grey-faced and sweating, as his heart fluttered erratically in his chest like a trapped sparrow. Now, he was scooting about in his chair, fancy-free, whilst his heart thumped away, strong and regular as a ticking clock.

I'd spent about ten minutes slowly going over the details of what had happened to his heart and the explanation behind his symptoms. Afterwards he seemed pleased, and said, "Do you have five minutes? It's not anything medical."

I nodded and followed after him as he headed down the corridor and out of the ward. Outside, sun was shining down on the ivy-covered perimeter fence, glancing off the leaves that were just beginning to show the season's colours.

Mr Wheels gestured towards the fence with his hands. "I have a lovely garden at home, and we've got a fence just like that, with a green climbing plant. I think I shall uproot it and replace it with ivy just like that. Look at those colours. So vivid!"

He folded his hands in his lap and sighed to himself.

"Ever since I had me operation, it's been hard to get about, but I can still manage in the garden, and that's one thing."

He looked intently at the stump of his right leg, with the trouser leg folded over and neatly hemmed.

"You like gardening?"

I told him that I loved plants but didn't have a garden. Our flat has a bit of green in every room, to keep the air pure. He smiled in agreement.

"I try to make things beautiful around me. There's so much horror in this world. Two days ago, I thought I was going to cork it, but it wasn't me time. You're from Singapore aren't you?"

I nodded mutely, shocked at the sudden change of subject.

"I recognise the accent. I was a soldier out there, just after the War."

He paused, watching a flame-coloured leaf that was floating by on the wind.

"I went to Changi then, and helped exhume the graves. Had to give them a decent burial, you know? Three hundred Chinese men made to dig their own grave with just their bare hands and then all shot to death, and then the bulldozers must have just covered them over, you know, a mass grave. It was horrible. But things like that happen all over the world, during all wars."

I asked him if he'd ever been back there, to Singapore.

Mr Wheels nodded vigorously, his grey eyes lighting up with the memory. "I loved it out there. Absolutely loved it. I went back there to work when I finished with the army. I was in construction. Raised my family out there for many, many years...real sad to leave, but my company sent me all round the world for all sorts of work. Been everywhere - America, Australia, the Middle East, you name it. And I went back to Singapore to visit a few years ago. Amazing! It looks so different now. You been to 'Underwater World'? Amazing."

He reached towards the ivy and plucked a few golden leaves off.

"You know, the best thing was all the festivals. The colours! So many cultures living together, there was a festival going on practically any day of the year. Celebrating life and living. That's what it's all about. Anyway, you best be going back in - you have better things to do than listen to an old man's nattering."

I told him that a man like him has better things to do than to waste his precious afternoon telling stories to a young whippersnapper. He laughed. I put my hand on his shoulder and thanked him for his time. Then, I picked up the flame coloured leaf that had come to rest on my shoe, dusted it off and gave it to him.

He wheeled himself back to his ward, and in a few moments, his grandchildren arrived for a visit, filling the ward with their childish laughter. I watched from a distance as he showed them the leaf I gave him, holding them up to the window to catch the light. They clapped their hands. Even the other patients began smiling and chattering to each other.

It was like a party.

Then I understood, that it was a party. It was Mr Wheels, celebrating.

Parking woes

At my hospital, working hours are as follows:

Nurses, healthcare assistants and A&E staff work early shifts (7am - 3pm), evening shifts (2:00pm - 10pm), late shifts (6pm - 2am), night shifts (7pm - 8am), and long shifts (8am - 8pm).

Other doctors work normal hours (8am - 6pm), unless we are "on call", which is roughly twice a week, in which case we work from 8am - 11pm. Once a month, we work a week of overnight oncall shifts (9pm to 11am).

Other healthcare staff (radiographers, physiotherapists, occupational therapists, porters, security) work normal hours with the occasional overnight shift.

Most of us drive to work and park within the staff parking lots.

This is because there is only one bus from the city centre to the hospital (45 minutes drive away). This bus only runs from 8am - 8pm. It does not run on Sundays. There is no available night bus.

Recently, hospital/NHS managers have decided that our hospital is in debt. One of the ways they have decided to get the Trust out of debt is by raising the carparking charges for visitors. In order to maximise the amount of revenue brought in by the car park fees, they have decided to reduce the number of staff parking lots in the hospital.

All medical and healthcare staff had to hand in their permits. New parking permits were issued by a lottery. Now, most of the nurses and doctors have to park in the nearest town, and walk into work. It is a 20 minute walk to the nearest carpark outside the hospital. This is not free, by the way - it's £5-10 a day depending on which car park one parks in.

You might think that this is okay - 20 minutes is good exercise. But most of the nurses and doctors who are working late or overnight shifts will have to walk 15 minutes through a dark, unlit field in order to get to their car. This is scary and dangerous.

We brought our complaints to the NHS managers about the new parking rules. We asked if staff could park in the visitors lots during night shifts. We asked if a shuttle service could be provided to the train station in the city centre outside working hours and on weekends.

Their answer? No. Carpool or share parking lots. Nice, non-feasible, non-practical options.

What really makes me unhappy is that the NHS managers and departmental staff (eg. payroll, medical staffing clerks etc) kept their allocated parking lots. NHS managers and secretaries only work 9-5pm, and they don't work on weekends! Why can't they take the bus to work or park in town then? Maybe they want to protect their Prada shoes and Savile Row suits?

Some of my nurses have handed in their resignation.

NHS managers out there? Nice work, guys. Thanks.

What to do in five hours

Standing and looking at our toes
Originally uploaded by Sunshine follows me.

We were standing and looking at our toes in our living room this morning, just standing and looking at our toes and wondering what to do.

I had the day off, and MDH's shift only began in the late afternoon. So we had 5 hours.

We could have spent the 5 hours sorting through paperwork (mostly bills and tax returns) that had been piling up around the house in great fluttering mountains.

But we decided that it was time to go exploring instead. Take in the lay of the land, as it were. Get some fresh air, stretch our legs, expand our horizons, and avoid getting papercuts.

So we put together a picnic (consisting mostly of orange squash, crisps and peanut M&Ms) and took the car for a ramble.

Soon we were standing and looking at our toes again, but this time on the beach.

Spurn me
Originally uploaded by Sunshine follows me.

The beach was by no means dilapidated - there were a few mums and tiny tots out for a stroll - but Spurn Head beach goes on for miles at low tide, so we soon found a secluded nook to enjoy our picnic.

There's something about sea air that makes potato crisps taste much more flavoursome.

MDH shut his eyes, leaned back against a large boulder, and contemplated calling in sick for the day. He did have a little sniffle. Unfortunately, his sense of responsibility was powerful strong, and an hour later, we were driving back to the city.

Perhaps we didn't achieve as much as we would have done, if we'd stayed at home this morning.

But it was a good waste of 5 hours.

Grand Rounds 3.1 Happy Anniversary

This week's Medical Grand Rounds is hosted by Enoch Choi of Tech Medicine. Go join in the party!

An argument

(alarm clock goes off. It's 6:30am)
MDH: (groans)
TSCD: Sorry, sweetie, I need a lift into work this morning...there's no bus links before 8am.
MDH: (groans)
TSCD: I'd drive myself in, but you need the car to get to work.
MDH: (groans)
TSCD: And...could you pick me up at nine tonight?
MDH: (groans)
TSCD: Yes, it means you'll have to get your own dinner too.
MDH: I'm not your bloody chauffeur!
TSCD: ...
MDH: I was on call until 2am last night and now I've only had 4 hours sleep and I have to take you into work!
TSCD: ...
MDH: I don't know when I've had a full eight hours sleep in the last three weeks!
TSCD:Well, I could always stay over at the hospital on the days I need to get there early.
MDH: No, that's stupid! Then I'll only get to see you twice or three times a week!
TSCD: Then what do you suggest I do?
MDH: (grumbles) Nothing. It's not fair, is all.
TSCD: Then, how? I need to get to work, you need the car, I try to take the bus but it doesn't run before 8 am, what do you expect me to do?

(Two weeks and 12 hours later. The mobile phone rings.)

MDH: I'm going to be late picking you up.
TSCD: What? Why?
MDH: I'm in Other County.
TSCD: What?! Why! You're supposed to be picking me up! The canteen is shut now, and I haven't eaten all day, I'm starving!
MDH: I was Busy.
TSCD: (annoyed) Busy with what? What were you doing all the way over in Other County?
MDH: I was busy. Look, I'm driving, I'll talk to you later.

(1 hour later, MDH arrives)
TSCD: What happened to our car? What is this?
MDH: This is your car.
TSCD: What? Why? When?
MDH: Here. He's yours. Drive us home, sweetie. And let me sleep in tomorrow, please.

Basil Featherstonehaugh
Originally uploaded by Sunshine follows me.

To do list

Looking out to the Humber
Originally uploaded by Sunshine follows me.

Here is my to do list for today...guess which tasks I've completed!

1.Buy groceries (need more eggs! and milk! and parmesan! and cereal! and fabric softener! and...)
2. Change fish tank water
3. Wash up dishes that have been piling up over three days
3. Change sheets and towels
4. Do laundry
5. Take car for servicing
6. Pack weekend bag for visit to Outlaws
7. Marinate chicken pieces and bung in freezer
8. Finish reading Cloud Atlas
9. Post letters
10. Arrange appointment at hairdressing salon
11. Take a stroll along the waterfront
12. Take a long afternoon nap
13. Complete income tax forms
14. Call parents
15. Daydream about Florida

Who's the boss?

A little boy of about 3 years old is happily playing on a plastic toy vehicle in the playroom of the department. His mother is sitting on the nearby bench watching him. She's brought him into the department because she is worried that he has a painful hip.

Approaching them from a distance, I can see that the little boy is scooting along quite well and using both legs with no problem. But, for the sake of his mother's peace of mind, I will give him a formal 'once over'.

I ask the mother to bring the little boy over towards me so that I can examine him. She stands up from her seat and calls to him, "Son, son, can you come over here?". Her son ignores her. She doesn't move from her spot, so I walk up towards him, and say, "Hey, could you go over to your mum and sit on her lap, please?"

He looks at me, and looks at his mother, and begins to yell. Loudly. Then, he slides off the seat of the plastic scooter so that he is lying flat on his back on the floor. He kicks his legs in the air at me.

"YARRRGHGHH!!"

His mother doesn't move or say anything.

So I say to the kid, "Get up from the floor please, and come with me."

"YAAARGHGHGH!!"

I look at his mother and motion to her to pick her son up off the floor. She does not move.

"YAAAARGHGH!!"

Her son is wiggling around on the floor, screaming and flailing his arms and legs. He looks over at his mother and notices that she has turned into a pillar of salt. Then, he turns over onto his tummy, looks up at me with a look of defiance, and then smashes his head into the floor.

He looks at his mother and screams again and tilts his head back again for another blow. His mother has gone all white and has taken two steps back.

Now, I understand. She's afraid of her own child.

Well, I'm not.

I put one arm across his arms and chest, and the other arm between his legs and pick him up the floor, still screaming and kicking.

Then, I plunk him down on a couch, and I say quietly, "Be quiet. There are sick children here trying to rest. Now. Stop. Shouting."

And he stops.

Mrs Salt has shaken herself out of her reverie and has materialised by my side. I fix her son (now whimpering quietly) with a stony glare, and say to her, "I don't think he has a problem with his hip. He is just fine. You may take him home now."

She nods her head sheepishly, watches as her son jumps off the couch and happily runs out of the department.

I wonder if that kid is going to get a scolding for his atrocious behaviour. But I sincerely doubt it. I reckon Mrs Salt will be the one getting the punishment - for the rest of her life.

Grand Rounds, Vol. 2 No. 52

Grand rounds this week is at Tundra Medicine Dreams. Please surf on by and check out what the medical blogosphere has to offer!

Now all I need is a pledge...

...and an anthem, and a tricorder, and one of them hyposprays...

(make your own seal)

Blue days

She looked sallow, even though her complexion was dusky. Her nails were beautifully manicured. I can see them even now: long curved nails painted a deep blue, each decorated with a silvery glittered swirl. Her index fingernail even had a little jewel stuck on the end, and it sparkled under the harsh hospital lighting.

I looked down at my own nails - filed short, with raggedy half moons - and hid my hands behind my back.

Madam Nails had terrible needlesharp pains in her ribs on and off for several months, and had been coughing up small amounts of blood daily for almost two years now. She had been seeing a respiratory consultant who had done some tests and lung biopsies, and was due to see him again in two days. But over the last few days, the pain had gotten much worse despite regular painkillers, and she came to hospital for advice on pain relief.

I asked her if she had used any pain relief stronger than paracetamol. Shaking her head, she replied that she was worried about using stronger analgesia, in case it interacted with her medications.

I enquired after her medications, and found out she was on a pill for her cholesterol. I smiled and told her that painkillers wouldn't interfere with the cholesterol lowering tablets. Then I ran through the usual list of questions. Any other changes you've noticed? No. Taking any other medications for anything else? No. Any allergies? No.

Any other medical problems? (pause) No.

Something went 'ping' in my head after her response to my last question. But I ignored it.

Anything else you think I should know? (long pause) No.

Another 'ping' in my head. I ignored it again.

I gave her some painkillers and she seemed pleased. Before she left, she asked if I had the results of her biopsies and blood tests. I had a quick glance on the computer at her results file and nothing was on it, so I told her that they were probably not ready yet. She nodded. I asked her to return if she was feeling worse. She smiled a tired, watery looking smile, and exited.

A few days later, I arrived at work and the departmental boss called me into his office.

"Did you see Madam Nails on Sunday?"

"Yes."

"She's dead. She was being rushed back into A&E about 18 hours after you saw her, and she died on the way. Looks like she had pneumonia."

My heart turned into ice. I looked down at my nails. They looked blue.

"Did you know that she had AIDS?"

I shook my head. I remembered the pauses. She had not told me. Why hadn't she told me? Did she not trust me as a doctor? If she had told me, I would have asked her to at least stay for observation, blood tests and Xrays. As it was, I thought she was being well looked after by a lung specialist.

Boss had looked through my notes and realised that I had acted as any other doctor would have acted based on the information I had been given. But that brought me no reassurance. In my mind's eye, I saw her cobalt nails, the dullness of her eyes, the deathly pallor of her lips, the rusty stains on her handkerchief, and I heard her voice, rasping in my ear.

I walked through the department, looking at my raggedy half moons, at the azure linoleum floor, at the distinctly navy nursing tunics, at the cerulean tinted hair of the old biddy pushing the tea trolley. Outside, the sky was sapphire.

Sighing, I picked up another folder of medical notes (indigo) and began to read.

Movie night

The food:
Bak Kut Teh (pork rib soup) with rice

The drink:
Ribena!!

The movies:
'Love Actually' (Colin Firth is So Hot)
'The Village' (Shyamalan is So Cool)
'Mean Girls' (Lindsay Lohan is So Well Endowed)

Unacceptable

It is not acceptable to ask a patient who is having an acute asthma attack to drive themselves from the A&E department round to the local cottage hospital just because that is where the respiratory specialists live. Especially if they aren't even well enough to walk.

It is not acceptable to shout at the nurse because she was five minutes slow to give you antibiotics. Especially when you clearly saw that she was with the patient in the adjacent bed who had just been told he has pancreatic cancer. Have some humanity, people.

It is not acceptable to tell a doctor that a locum had been hired to cover her on-call shift whilst she was on three days compassionate leave, and later tell her that she would have to take a pay cut that month because she had worked three days less.

It is unacceptable to allow your visiting child to enter the doctors treatment room wherein lie all manner of sharp objects, and then shout at us when we kick him out and forcibly remove from his possession a half opened suture kit. Scalpels are not toys.

Who knew?

Her wet hair glistened in the light and the smell of chlorine wafted through the air. Her eyes were screwed up in pain and she clutched at her belly, drawing her knees into her stomach.

The nurses struggled with their scissors, trying to cut off her neon pink and orange swimsuit. They muttered under their breath and cursed the inventor of spandex. The paramedics were talking to the head nurse in the corner, and I managed to catch the words "swimming instructor" and "collapse" as I walked in through the doors.

"The pain goes on and off and started quite suddenly this afternoon. Pain seems to be easing off now."

Miss Neon sat up feebly and we managed to have a short conversation before she was hit by another wave of pain. No, no bleeding. She'd opened her bowels this morning. No burning on urination. Period? Two weeks ago, regular as clockwork. She had noticed some watery discharge from 'down below' this morning, just before the pain got bad...but she ignored it and went off to the pool. Oh yes, and she'd put on a little bit of weight recently and had been feeling quite washed out - but then again, she'd only just broken up with her boyfriend.

"It's not anything serious like appendicitis, is it, doctor? Because I'm flying to Canada tomorrow - been planning it for months. I've got a house out there now and it's gorgeous, and I can't wait to move there and get off this dreary island. Oooh, the pain is coming back again."

I looked at my watch. Odd how the pain seems to come and go every couple of minutes.

"Do you mind if I have a quick look 'down below'? I know you're in alot of pain but it will only take a second."

I looked under the sheet.

Then I turned to the nurse and said, "Get help. Now."

Then I looked at Miss Neon and said, "Ma'am, I have some news that will probably shock you. You are not having appendicitis. You are having a baby and you are having it right now."

Miss Neon screamed.

"Did you know you were pregnant?"

Miss Neon screamed and carried on screaming.

She was still screaming when her baby, a healthy and bonny little boy, took his first breath.

She was still screaming when we placed her child in her arms.

And then she cried.

Later on, I went to the lunchroom to sit down and gather my nerves.

The nurses watched at me as I walked in, sat down and put my feet up on a stool.

One of them said to me, "So she was nine months along and still wearing the same swimming costume?"

I nodded.

She looked down at her swollen pregnant belly (on which was balanced a tupperware laden with pasta) and sighed, "Nothing in my life is fair."

Thoughts on 'The Wicker Man' (c1973)

1. These old movies contain alot more nudity than I had expected. What's the rating on this DVD box...15?! 15?! Shocking! Scandalous!

2. Happy background music combined with sinister onscreen activity makes everything all the more creepy and disturbing.

3. [outside, several young girls are dancing naked over a fire]
Sergeant Howie: But they are... a-are naked!
Lord Summerisle: Well, naturally. It's much too dangerous to jump through fire with their clothes on.

4. Is this a musical? There's alot of singing going on. Especially around that campfire they made at the end *shudder*.

The Morning After

So, I guess my last post needs a little explanation, but first let me fill in the background details first.

I personally believe that life begins at conception. The word 'conception' (for me, at least) is when sperm fuses with an egg to create the human foetus. This is how I define it - it is by no means the medical definition of the beginning of human life.

The current 'morning after' pill is made out of female hormones. The hormones used to make the 'morning after' pill are the same as those used to make the oral contraceptive tablets, but a much larger dose.

The oral contraceptive tablet works by suppressing ovulation, that is, the release of the egg from the woman's ovaries. The oral contraceptive tablet works by maintaining the female hormones of the blood at a certain concentration which causes the ovaries to 'sleep'. This is also how the 'morning after' pill works. No ovulation = no egg = no conception = no pregnancy.

As the 'morning after' pill is a massive dose of hormones, it can suppress ovulation much quicker than the oral contraceptive tablet but it also has a greater effect on the rest of the body in terms of side effects, which is why it is used only in emergencies. Since the hormones in the pill need time to act, emergency contraceptive pills should be taken as close to the time of sex as possible in order to prevent ovulation (and by extension, pregnancy)- the recommended time frame is within 12 hours.

So, as you can imagine, the 'morning after' pill will not prevent pregnancy in someone who has already ovulated or is already pregnant. It will also have no effect on an existing pregnancy.

A woman who has used the 'morning after' pill usually bleeds a few days afterward (although not all women will bleed). This has to do with the natural response of the body to the changes in hormone levels in the blood. This has nothing to do with the bleeding associated with the loss of pregnancy.

(There are tablets available that one can take in order to effect an abortion. These are different from the 'morning after' pill, and are only available to women who have decided to have a medical termination of pregnancy and who have had the necessary counselling by their doctors. These tablets are only given in a hospital setting with proper monitoring for at least 24 hours.)

So, now that I have explained how the 'morning-after' pill works, I hope you can understand why it is something that I can happily offer to a woman who has been raped.

And there are other women out there, perhaps, who have used the 'morning after' pill in the past, and currently feel guilty about it. I think it is important for them to know how emergency contraception works - life is hard enough without all the emotional baggage.

Note to self

Must remember to tell all my patients (and friends) that the 'morning-after pill' is not the same as an 'abortion pill'.

This is particularly significant for women who have been raped. The last thing a rape victim needs is to be saddled with a 'life or death' decision that can potentially cause a lifetime of pointless guilt.

Movie Night

The food:
Tortellini Arrabiata

The drink:
Cherry coke

The movies:
The Wickerman (The Christopher Lee version)
Miller's Crossing
Malcolm X