Spammity spam

MDH came home giggling to himself today. Why? I asked him, why are you giggling? Have you done something naughty?

MDH giggled to himself some more. He tells me that he spammed his consultant's email.

By accident?

Oh no.

He wanted to find out if the Dr Grumpy's email address (given to him reluctantly by Dr Grumpy's secretary) was correct, but he didn't want to write an irritating 'testing, testing 1 2 3' email.

So, he made up a spam email from his secondary email address (the one we use for registering for online newsletters) and sent it off to Dr Grumpy.

How does one make up a spam email? Easy, says MDH. Advertise some random product using poor punctuation, bad grammar and worse spelling.

example:
"Buy you orangge freshness here. mandrake says is the good! Yes...No! ClickclickclickityclickHEREbuyNOW"

*headdesk*

Don't try this at home.

A Good Day Off

Today, the plumber came and finally fixed our shower. It has been broken for the last two weeks, ever since the day I noticed that the plastic casing of the heater box looked slightly warped, and MDH opened the heater up to find a sticky, melted mess and some exposed wiring.

Hooray, hooray, hooray for hot running water! I am so sick of bathing using a flipping plastic scoop.

In celebration, I have made brownies. I have also decided to make stuffed portabello mushrooms and lasagne for dinner. Yeah, baby.

Hazy days of summer

In the garden
Originally uploaded by Sunshine follows me.

So it's the weekend, and I'm stuck in the Acute Admissions Unit waiting for the ambulance crews to wheel in the sick and infirm. It's cold and grey outside, very rainy, very icy. I can't help thinking of the long, warm, summer days MDH and I spent down on the south coast of England earlier this year.

As some of you may recall, to celebrate our wedding anniversary, I secretly booked a room at a fancy B&B and whisked MDH off for a romantic weekend away.

It was lovely - the family-run B&B was a converted old railway station tucked away in a corner of the New Forest. The lady of the house made her own bread and preserves, and she had a small vegetable plot out the back (which meant organic grilled tomatoes for breakfast).

There was a beautiful garden with sweet apple and pear trees, laden with fruit, and an enormous silver birch tree. MDH and I spent our evenings sitting on the iron bench underneath the silver birch, and playing with the friendly dogs that belonged to the family.

Stonehenge
Originally uploaded by Sunshine follows me.

We visited Stonehenge early in the morning that weekend. It was just after the summer solstice, so the hippie community were still camping around the site, waving mistletoe and singing folk tunes.

It wasn't too crowded that day (we got there early enough to avoid the tour buses and school kids), so we had the opportunity to enjoy the sunshine and walk slowly around the stones.

Afterwards, we decided to drive to the coast to visit Ludworth Cove and Durdle Door. It was very hot, so we each had an ice cream cone before walking down to the shore and paddling our feet in the sea water.

Durdle Door
Originally uploaded by Sunshine follows me.

There were lots of people climbing up on the rocks and diving into the sea. Unfortunately, neither of us had thought to bring our swimming things, so we watched in envy from the shore. MDH rolled up his trousers and went splashing about in the shallows, but it just wasn't the same.

With the crumbs from our baguettes, we fed the seagulls and watched them squabble on the sands. It was far too hot that day to stay out in the sun for too long, and we found ourselves scrambling back to the car, hot and sticky and driving back to the cool shady garden of the B&B.

Please take me with you
Originally uploaded by Sunshine follows me.

We were very reluctant to leave our haven after that lazy weekend. As we got into the car to leave, the family dog hopped into the passenger seat and made himself comfortable. He looked at us under his bushy ginger eyebrows. He whined when I carried him back to the house then ran towards the driver's side and tried to crawl under MDH's leg.

I'd have welcomed him gladly as a stowaway, but MDH insisted that we shouldn't start a career as dog-nappers...so I reluctantly returned him back to the house a second time.

He ran, barking indignantly, after our car as we drove away.

Going to work

I love going to work in the mornings because I get to drive my lovely Mini and the route to work is pleasant. My Mini is my little haven - I'm surrounded in music and gorgeous scenery, and I'm singing at the top of my lungs. It's a great start to the day.

As I drive away from my apartment, I encounter rows of pre-schoolers walking to kindergarten. Some of them are accompanied by their parents or older siblings, holding their hands or shouting at them as they skip on ahead. When it rains, there will be a parade of multicoloured welly-boots, and much splashing about in puddles. If I leave early for work, there will be a young lady in a grey trenchcoat taking her beagle to the park, his tail held stiff and straight up in the air like an aerial. The yellow suited lollipop man stands in front of me, arms held out, so that the children can cross the road. When they are safely across, he waves at me and I wave back as I drive on by.

There is always slow traffic on the bridge leading to the Perpetually Jammed Roundabout (or the Jammy Doughnut, as MDH and I call it). I'm okay with this, because the bridge spans one of the tributaries of the Humber River, and I get to slow down enough to appreciate the rising sun sending sparkles over the gold water. On a cold foggy day, the river is mysteriously grey. When it rains, it looks forebodingly black. If I'm lucky, there will be porpoises.

Once I hit the motorway, Basil the Mini roars to life and my speedometer jumps from 40 to 70 as I overtake the slow moving lorries and container trucks. On one side of me is the river lined with tall brown catkins, on the other, there are train tracks and a graffiti-covered stone wall. The fast train to London whizzes by, a blue and silver blur.

Then, I turn off, and drive by the open fields of the Yorkshire Wolds, sparkling with the morning dew. More often than not, Basil ends up queuing behind a tractor or combine harvester of some sort. No matter. I look out my window as I tootle along. Sometimes, there are shaggy brown horses peering at me from over wooden fences. Other times, a started pheasant will fly over my car in a flash of green and red tail feathers. Or maybe I'll catch a glimpse of Flopsy, Mopsy and Cottontail disappearing into a roadside burrow.

When I reach work, I'm bright, cheery and surprisingly rested. It's all good.

Fun with urine dipsticks

Today, I have made the horrible discovery that my tap water has a pH of 5. However, once I filter the water, it has a pH of 7.

What the heck is in the drinking water up here?

Grand Rounds Volume 3, Number 9

The Medical Grand Rounds this week are held up at Doctor Anonymous. Do surf on over and see what the medical blogosphere has to offer this week!

Vitalstatistix

My best friend from college is getting married, and I'm going to be her matron-of-honour. (I hate the word "matron". It makes me feel like I should be middle aged and fat and have a heaving bosom.)

Her mum is making all the dresses, but she lives hours away on the other end of the country - so she sent me a chart with all the measurements she requires to sew the dresses. Hence, MDH and I found ourselves doing the tango with tape measures yesterday evening.

MDH was in charge of recording my dimensions and he was very happy to do it. The agreement between us was that I wouldn't ask him to read the figures out and he wouldn't laugh. However, the minute he finished measuring my waist, he emitted muffled giggle:

MDH: (muffled) teeheehee!
TSCD: What? What?
MDH: Oh...nothing.
TSCD: What do you mean 'nothing'? What did the tape measure say?
MDH: It's not important...and you said you wouldn't ask.
TSCD: Well, you broke your end of the bargain. Now spill it.
MDH: No.
TSCD: (whining) Come onnnn...tell meee....
MDH: Okay, it reads "X+2" inches.
TSCD: "X+2"? "X+2"?!!
MDH: Why?
TSCD: That is totally unacceptable! "X+2"! Argh!
MDH: "X+2" is by no means fat, you know.
TSCD: When we were married, it was "X-1". It can't be "X+2".
MDH: Well, that was years ago. You're different now.
TSCD: Not that different. I still fit into the same jeans. (jogs on the spot for a bit) Measure me again.
MDH: But, dear...
TSCD: (growling) Measure again!
MDH: "X+1" inches.
TSCD: AAAAAAAARGH! No! No, no, no, NO! You are WRONG!
MDH: (laughing) Well...then what would be acceptable?
TSCD: (thinks for a bit) "X".
MDH: Okay, this is "X". (wraps measuring tape around TSCD)
TSCD: Hurts...Can't...breathe...*choke*...
MDH: I think "X+1" is okay.
TSCD: (grudgingly) I guess.

Well, at least I know where the five kilogrammes of chocolate weight have gone. *sigh*

Eaten away

When he first walked onto my ward, red-faced and nostrils flaring, making his way slowly but determinedly down the corridor, I had assumed he was a irate relative coming to pick a bone with me about one of the patients under my care.

As he reached the nurses' station, he demanded to speak to me. His chin was quivering with exhaustion, his voice was hoarse, his words were wheezy, the tendons in his neck stretched and strained. Then, I knew how sick he was.

Earlier that day, he had gone for a chest radiograph and a CT scan before arriving on my ward, the results of which showed a several large tumours sitting on each lung, which was also half filled with fluid. He had been shown the scans and X-ray films, and had been told by the consultant that it was likely to be lung cancer.

"But, I don't believe him!" he declared, "It all sounds like a load of hogwash and I'm not buying it. So, I don't want any more of these rubbish tests." He started to gasp for breath and I put the oxygen mask over his face.

I explained to him that we needed to get a biopsy sample of the tumours to see what they were made of. The sample is obtained via bronchoscopy, which means using a telescopic camera to look into the breathing tubes of the lungs. This way, we could find out what the best treatment for him would be.

"No! No more tests. I don't think it's cancer, and I don't believe what you say about it."

I tried talking to him about using very fine needles to suck out some of the fluid that had been building up inside his lungs - we could send some of it to be looked at under the microscope, and he would be able to breathe better without so much fluid sitting on his chest.

"Don't you understand? I said no more tests. I mean it. No more tests."

I pointed out to him that he was already having difficulty breathing, and then there was not much we could do except give him simple treatments to support his lungs and prevent infection. Without a tissue diagnosis, we would not be able to give chemotherapy. Radiotherapy could be an option, if he would accept that.

"Radiotherapy? What for? I don't want it. I don't have cancer, I don't care what you say, I don't want it. Let me go home."

I put on my sternest doctor voice and told him that if he could manage without the oxygen and look after himself, then he could go home today. If he could not, then he would have to stay with us until we had his home outfitted with all he would need. This could take several weeks. He grew quiet.

Later that afternoon, his daughter walked onto the ward, red-faced and nostrils flaring, making her way determinedly down the corridor to see me. Irate, she demanded that we carry on with the tests and start the treatments necessary.

I asked her if she had spoken to her father about it. She shook her head, angrily. "He's a stubborn man, and won't listen to me anyway."

Gently, I explained to her that we cannot force her father to undergo invasive testing or arrange treatments for him that he will not accept.

She stared at me, eyes wide with horror. "Are you just going to let him die?"

I looked at her levelly and reminded her that there is no cure for cancer, especially one that seems to be at an advanced stage - all the measures we would have are either for holding off the inevitable so that affairs can be put in order, or for reducing discomfort. Her father had chosen to fight his illness on his own with as little intervention as possible, and we had to respect that. He had chosen to let nature take its course and I had to respect his choice.

Yes, I am letting him die.

There was fire in her eyes and I knew that she hated me then.

Day after day, I would talk to Mr Stubborn in the morning, and try to persuade him to undergo tests and receive treatment. He would refuse. In the afternoons, his daughter would visit him and try to persuade him to accept the tests. He would shout at her and tell her to get out. She would leave the room, then rail at me for my ineptitude. I began to think I would burst into flames whenever she looked at me with such hatred.

Soon, Mr Stubborn was too unwell to undergo any tests, even if he had agreed to them. By then, he had lost his robust figure, his weight falling off him as the growing cancer leeched away more and more of his energy. His bones showed through his skin, his eyes were filmy and dull, his lips puckered like a prune. He occasionally refused medications. He only accepted what could be delivered through his oxygen mask, and perhaps the occasional paracetamol for pain. He would not touch the steroids or the antibiotics. He would not allow us to give him morphine.

Looking at him, I remembered a piece of installation art from the Museum of Contemporary Art in Chicago. It was by a young man called Felix Gonzalez-Torres. His work was a pile of candies, in shiny metallic gold and silver wrappers, laying in a corner of the room. The weight of the pile was equivalent to the weight of the artist when he had first been diagnosed with AIDS. Visitors were encouraged to take a piece of candy from the spill. My piece was a chocolate covered toffee. Slowly, the sweet stack diminished in size, slowly eaten away, until nothing was left.

One afternoon, his daughter sat down with me for another session of "You Doctors Are So Incompetent". I sat in silence for a while after she finished speaking. Then, I said quietly, "It's very frustrating for me to watch him deteriorate like this and not be able to do anything to help him. I cannot imagine what you are going through, being his daughter."

The fire in her eyes spluttered and died. She burst into tears and wept uncontrollably, and I wept with her. She did not hate me, she did not hate him for being so proud and she did not hate herself, either.

Afterwards, when she visited her father, she would sit in his room, in silence. He did not shout at her or tell her to leave. Instead, he would talk about the weather, complain about hospital food and talk about his grandchildren. She told inappropriate jokes about Irishmen, popes and rabbis, and ducks walking into bars.

He died soon after.

Float by my window

Here I am, all snuggled up in MDH's old jumper, drinking some homemade leek and potato soup.

It has definitely gotten a whole lot colder this week. I accidentally left the kitchen window open today when I was out doing the shopping. Now the whole house is freezing, which gives me an excuse to warm myself up with a hot chocolate. With marshmallows. Heh heh heh.

This week, the local dryads have traded in their green uniforms for the blazing fall colours.

It has been such a delight, passing through the tree-lined streets every morning, each tree awash in ambers and reds, signalling the new season. My duffle coat has made an appearance from the depths of the closet, along with my new white wool crochet scarf and trusty old suede gloves.

I'm clinging on desperately to the vestiges of summer - namely, my smart knee-length pencil skirts. My last pair of formal trousers finally fell to pieces this week, so I literally have nothing to wear to work (and I'm not going to buy any more trousers until I have a chance to visit the factory outlets in America.). Hence, I have decided to invest in tights to keep my legs warm and toasty.

So, I went out today and bought a pair of nice black pantyhose from M&S - 60 denier, so they are quite warm. When I got home and tried them on, the gusset was too long for my petite Chinese frame. Practically stretched them up to my armpits trying to get them on.

I think I will have to resort to using holdups instead of pantyhose. Does anyone know any good brands of holdup tights that won't slip or roll down?

Lesson #1:Trust no one

Today, I have learned a very horrible and valuable lesson about trust.

When I say "yes", I mean "yes". When I say "no", I mean "no". When I give advice, I only say what I know and nothing else. If I don't know how to answer, I say that I don't know. It is unacceptable to equivocate and confabulate information in my line of work. My word is a promise.

This is not the case, however, with Other Folk.

I have learned now that everything must now be written down, recorded, duplicated and kept safe for all eternity because one day I'll need it. The world is not a safe place. Don't throw anything away and never delete any emails! Everything must be collected for evidence! It's all evidence!

Evidence for what?

Evidence so that when the situation goes awry and Other Folk deny all knowledge of any verbal agreements made or bad advice given, then one can prove that one's actions were justified.

As it stands, it is my word vs. their word, and I have no names, dates or phone numbers or any written documents.

In short, I am currently knee deep in Hospital Policy guano, having been royally screwed over by the bats working at Hospital Management (and the night crawlers who work for Hospital Management who gave me false advice about Hospital Policy).

I do not want to deal with hospital management, hospital policy or bat guano. Leave me alone please, so I can do my job. Please! I want to do my job, and I cannot do it properly if I have to carry all this manure. It's unhygenic!

All I want to do is look after my patients. I tried to make sure that they were being looked after, but the people I trusted to help me achieve this goal...well, they didn't honour their word. Trust means nothing! And now the witch hunt is on, and guess who's gonna get thrown into the duck pond? Me me me me!!

The worst thing is, if I didn't give a care about my patients, I probably wouldn't be in this situation.

Maybe I should just frigging quit.

(But if I did...who would look after my patients?)

*derisive cackling*

Movie Night

The food:
Grilled tonkatsu beef
Baked potato with homemade salsa and creme fraiche
Roasted carrots and mushrooms

The drink:
Bacardi spiked pineapple juice

The films:
'Walk the Line' (Johnny Cash! Whooooo!)
'School of Rock' (Jack Black! Whooooo!)
'The Da Vinci Code' (a very, very disappointing film, I must say. I expected more from Ron Howard. I guess there was too much conspiracy theory to fit into so few hours.)

Time out

I have been sick all this last week.

I will post more when I can actually sit up for more than five minutes at a time.