Birds at Bempton

Inspired by budak's ecoadventures in Singapore, I decided to drive to Bempton Cliffs to see the seabird colonies. Bempton Cliffs is one of many lovely sites under the watchful eye of the Royal Society for the Protection of Birds (RSPB), which is a UK charity that tries to preserve healthy habitats for birds (and other wildlife). Numerous species of seabirds gather here to breed, and it really is a sight to behold.

All the Birdwatchers were out with their birding notebooks, huddled together with their binoculars and cameras, at various lookout points along the coast. Most of them were jostling for a good position to set up their telescope stands, their dark green and grey macintoshes rustling and flapping in the wind. Occasionally, one of them would let out a squawk of excitement and soon, all of them would be hunched over their scopes, twittering enthusiastically.

The Outlaws, bird fanciers themselves, had lent me their telescope and stand so I appeared keen enough to be allowed to stand with the Birdwatchers and set up my equipment. They soon realised that I was an amateur and were kind enough to help me with identifying different species and tell me a little bit about their habits. It was difficult to hear them over the deafening ruckus of thousands of mating seabirds, but these were hardcore Birdwatchers whose patience had been tried and tested from years of stoically standing in rain and mud just to catch a glimpse of a rare feathered visitor.

It is puffin breeding season at the moment, so I was fortunate enough to spot a several puffins standing in front of the deep cracks and holes in the cliff wall where they make their nests. They looked really sweet, with their clown faces and orange feet.

I watched in awe as huge white gannets with their rusty heads flew up into the air, tucking their black-tipped wings in before they plummeted a hundred feet into the sea.

Little black-backed guillemots and razorbills stood in pairs, performing complicated dances of courtship, bowing, bobbing, occasionally pausing to scrape their beaks affectionately against each other whilst perched on the sheer cliffside.

I fiddled inexpertly with my camera, taking pictures through the lens of the telescope (hence the questionable quality of my pictures). I was very careful to try to stand upwind of the colony, in order to avoid being overcome by the incredible stench of guano and decomposing fish.

And here is my best little movie of the puffins. I'm rather proud of it, really.

Aren't they sweet?

Incidental evenings

Incident forms are the bane of my life. I have to fill one out for every accident or 'near miss' that happens to a patient during their admission in hospital. The nurses initiate them - my job is to check the patient over and see if they need any extra treatment or first aid, then complete the rest of the form and sign my name at the bottom.

After the forms are filled in, they are sent to a secret place where they are dealt with by unnamed persons. Judging from the number of forms I have to fill out every night and their content, I assume the forms are "dealt with" by dealing them into the nearest bin-lined receptacle.

Here are the top 5 incident forms from last night: -

IF#5: Here we have a prime example of nurses using their common sense.
Time: 0130h
Nurse: Patient fell from chair to bed. Doctor called.
TSCD: Patient got up from chair and sat heavily on bed. No injuries. No action needed.

IF#4: This is proof of the high standards of care provided by the night staff.
Time: 0030
Nurse: Patient found sitting on floor. Doctor called.
TSCD: Patient needed help walking from toilet to bed. Called for assistance. Decided to squat on floor whilst waiting. Could not squat any longer, so sat on floor instead. No injuries. No action needed.

IF#3: Submitted as evidence of well-honed obervational skills.
Time: 0335
Nurse: Patient has a bruise on his arm ?fall
TSCD: Patient sustained bruise on arm where had traumatic venflon insertion one week ago. No new injuries. No action needed.

IF#2: Ever wondered what insomniacs do?
Time: 0450
Nurse: Patient tripped.
TSCD: Patient tripped on own slippers whilst demonstrating salsa move to ward staff. No fall. No injuries. No action needed.

and the #1 incident form of the night is...

Time:0250
Nurse: Patient found in bed with face pressed against cotside ?head injury. Now agitated.
TSCD: Patient sleeping sitting up. Used cotside as headrest. Woken up by nursing staff, felt extremely annoyed. No injuries. No action needed.

Bleeping Bleeps

Shift starts at 2100. On-call bleep collected from day shift SHO.

Bleep record as follows -
2105: Ward G1 - organise central line insertion for patient. Please prescribe more fluids.
2107: Ward G2 - new patient on the ward needs clerking, more fluids please, drug charts need reviewing
2112: Ward L - Mr D pulled out venflon, needs a new one, more fluids please
2115: Ward K - rewrite drug charts and prescribe more fluids
2232: Ward G1 - patient fallen out of bed, please fill in an incident form and review him and we need more fluids writing up.
2245: Ward L - Mr D pulled out venflon again, needs a new one, please rewrite drug charts.
2253: Ward G2 - Please prescribe some antiemetics and analgesia for our patients. Mr G is complaining about his methadone regime, can you please reason with him?
2301: Ward L - Mr D pulled out venflon yet again, needs a new one
2312: HDU - Mr C is confused and agitated, please come and sedate him before he yanks out his arterial line. Oh yes, and we need more fluids writing up.
0009: Ward G1 - repeat clotting screen on patient for central line insertion
0016: Ward L - Mr D has fallen over and his venflon is out (again), please fill in an incident form
0023: Ward K - 2 patients now acutely short of breath, please review them
0100: Ward H - Doctor Ward H has gone home sick, can you please take the bleep from her and cover her 4 wards thankyouverymuch.
0112: Ward E2 - Patient vomiting blood come NOW!
0113: Ward H - Three new patients have arrived, they need to be clerked in.
0114: Ward E1 - Mr A's oxygen saturations are dropping, can we increase his oxygen?
0212: Ward G1 - Patient complaining of chest pain
0248: Ward G2 - Patient having a fever
0259: Ward L - Mr D is settled now, thought you'd like to know
0303: Ward G1 - Patient's chest Xray is available for review
0315: Ward K - Patients' chest Xrays are available for review
0344: Ward E2 - Patient pulled out nasogastric tube, needs a new one, and there's an abdo Xray that needs looking at
0450: Doctor Ward B- Things are quiet for me so I can take the extra bleep off you, meet you in 10 minutes!
0455: Doctor Ward B- Scratch that, things have just gone crap on my end. Knew I shouldn't have said the 'Q' word
0511: CARDIAC ARREST WARD B CARDIAC ARREST WARD B
0623: Ward E1 - Don't forget repeat arterial blood gases on Mr A and his blood results are back
0745: Doctor Ward B -Breakfast time, see you in the canteen in 10 minutes!
0752: Doctor Ward B - Scratch that, make it 20 minutes, I have to go to Ward C first.
0805: CARDIAC ARREST WARD C CARDIAC ARREST WARD C
0935: Day Doctor - Sorry I'm late! Where are you?

Hooray for the NHS Trust

There is not a single bag of normal saline to be had in this entire hospital. Saline is the most basic, cheapest solution used for intravenous fluid replacement. And we have Run Out.

In the ward I'm in, they have 2 dextrose-saline 500ml bags and about thirty 100ml bags of 5% dextrose solution. That's all there is left. There are probably about fifteen patients up here who need fluid replacement overnight. The nurses are desperately ringing around all the other wards to borrow saline, but there is none to be had. Except in ITU - they prefer to use Hartmann's solution there, so they had a few bags of saline in storage.

The ability to acquire goods from other wards is requires the use of high level bartering skills. The chief nursing sister where I am working is especially good at bargaining, having had much training at the local fish markets and carboot sales.

Ward nurse : I'll swop you one bag of normal saline for 2 packs of paracetamol and a banana.

ITU nurse: Are you kidding? A bag of saline is going for at least 3 packs of paracetamol, 10 teabags and 4 apples!

Ward nurse : I'll throw in the use of our healthcare assistant for 1 hour, and 5 teabags but no banana.

HCA (in the distance): HEY!

ITU Nurse: Fine. It's a deal.

Ward nurse: It's a pleasure doing business with you.

But after all that, she only managed to acquire 3 bags of normal saline. This is just great.

Maybe, we can get all the nurses to squirt 10ml saline tubes into the patient's lines every two minutes. Or maybe we can do it Catch-22 style - just attach one bag to the arm, one bag to the urinary catheter and do a switcheroo every eight hours.

Or maybe the NHS Trust will just order in more saline, like the nurses asked them to 3 weeks ago, Instead of spending the money replacing all the 'Handwashing is great!' posters in the hospital and repainting the managers' parking spaces!

Grand Rounds Vol 3, No 31

This week, Grand Rounds is located at Med Valley High where our host, Liana, leads us on a journey through the medical cosmos.

I particularly enjoyed the letter to the producers of medical devices by Diabetes Mine - its a bugbear of mine, seeing patients (especially kids) with chronic illnesses carry ugly-looking medical paraphernalia. Why can't inhalers come in 'Buzz Lightyear' and 'Power Rangers'? I'm sure more of my teenaged diabetic girls would be more compliant if they could carry insulin pens that were pink and encrusted with crystals.

And while we're on the subject of encouraging compliance with medical treatment, check this discovery by Dr Deb Serani - a Nintendo therapy game!

Hideaway

I was just sifting through my photos trying to find a new picture I could use for my blog which still preserve my anonymity. Something that shows part of who I am without giving away too much information.

I guess if my friends accidentally stumbled onto this blog, they will quite easily figure out my identity. The way that I write is exactly the same as how I talk - I do all my editing in my head - so if you think you know who I am, you are probably right.

The main reason that anonymity is important to me is because of the patients that I describe. I work very hard at keeping patient confidentiality because I have to respect the trust that my patients have in me. In my descriptions, I make caricatures instead of portraits - I do not include clinical details that would allow my patients to be identified. The emphasis of my writing is on my interaction with patients and their impact on me. In a sense, my readers should be able to look out through my eyes and see my patients. However, what they see is distorted by the kaleidescopic lenses of my mind.

I suppose if somebody knew my identity (and my employment history), that person could potentially identify every single patient I have been in contact with, just by looking through the clinical records of each hospital. So, I suppose that one could argue that patient confidentiality is at risk.

I doubt that any of my patients would be able to identify themselves just by reading my blog. This is because of the type of patient that I choose to describe - and I choose them very carefully. The patients that I write about can be found in any hospital in the UK, where there are thousands of hospitals and millions of patients. So if you think that I am writing about you or someone you know, then you are both right and wrong at the same time.

I suppose writing about my patients will get much harder if I decide to move to Singapore. Singapore is a small, small place. I will have to be even more careful. Or do you think I should stop the medical side of my bloggin altogether?

We shall see.

(Oh yes, and what do you think of my new photo?)

Movie Night

The Movies:
Johnny Mnemonic
Keanu Reeves before he discovered his acting skills. It's more or less Pinocchio on screen until the bit when he screams "I want room service!!" and starts hamming it up a little.

The Holiday
Despite the jerky and awkward transitions between the two narratives...no, who am I kidding? as far as chick flicks go, this was rather poor. But Jude Law and Jack Black? Niiiice.

The Food:
Pre-show dinner at the local pub - peppered steak with all the trimmings.
Chocolate mints from Lindt
Hula Hoops - original flavour

The Drink:
Ribena

Further adventures of Hello Kitty

Today, I have had the opportunity to have both a medical student and a pre-registration house officer (i.e intern) 'working' with me today.

Please note that the word 'working' is in inverted commas. This is because I was doing the work, whilst tidying up after my student and house officer. They are both lovely girls, as cute and keen as puppies and just as prone to accidents on the carpet.

I decided to teach them how to review patients on a ward round. On a ward round, one usually has about five or ten minutes to spend with each patient. This is because our ward has about 30 or so patients - so ward rounds can last up to six hours if we aren't careful with our time management.

Our first objective on the ward round is to ascertain if a patient is stable, improving or deteriorating and what outstanding investigations have yet to be completed. Our second objective is to identify new problems. This is actually more difficult as it sounds, because time is so pressing, one has to learn to be able to conduct a very brief interview with the patient - no time for idle chit-chat.

So when the patient starts to ramble on about something bizarre or inconsequential, this calls for the use of the 'Hello Kitty' expression. My student and house officer have not yet mastered the 'Hello Kitty' expression which led to disastrous results.

Case #1:
(Correct use of 'Hello Kitty' expression)
Rambler 1: ...it was yellow and it tasted like cheese.
TSCD: I see.
Rambler 1: But other than that, I have nothing else to report.
TSCD: Be sure to let me know if you do.
Rambler 1: I shall.
.....

(Botched attempt at 'Hello Kitty' expression)
Rambler 1:...it was yellow and it tasted like cheese.
Student puppy: (eyebrows frozen as per 'Pekkle') I see.
Rambler 1: Well, not the cheap kind you know. The really expensive Stilton with the purple wrapper that you get in the 'Taste the Difference' range at Sainsbury's. My wife only lets me have that once a week because I have bad stomach gas afterwards and it makes the house smell like sewage, although if you ask me, I like my natural smell, it's comforting....(enters the realm of Too Much Information)

Case #2:
(Correct use of 'Hello Kitty' expression)
Rambler 2:...and then I collect it into a little jar and keep it in the fridge.
TSCD: I see.
Rambler 2: But it's not infected or anything, so it doesn't bother me.
TSCD: Let's keep an eye on it, okay?
.....

(Botched attempt at 'Hello Kitty' expression)
Rambler 2:...and then I collect it into a little jar and keep it in the fridge.
House puppy: (eyes frozen in mid-twitch as per 'Bad Badtz Maru') I see.
Rambler 2: What? What? Is that not a normal thing to do? You young people are so rude. I've been doing this for years for my tomato plants. It makes a nice paste and seems to scare off the slugs. I also collect other things in jars such as....(enters the Realm of Too Much Information)

.....

Fortunately, I was around to curtail the discussions, otherwise we'd have been there all day.

I comforted the traumatised puppies afterwards and gave them a little treat. After all, we all have to start somewhere.

Hooray for Hello Kitty

"I was a merchant seaman, you know, so I don't need Viagra."
"Sometimes, it just can't get in."

One of the most important things a doctor needs to do is cultivate an excellent bedside manner. This is the key to establishing good patient rapport. By making a patient feel safe and comfortable, he or she is more likely to reveal those details about his or her life that is so integral to forming a diagnosis and later, a management plan.

"...it was yellow and tasted like cheese..."
"Sometimes, it just can't come out."

Very occasionally, a patient reveals far too much information than is actually needed. I always feel very flattered that my patients trust me and feel that they can confide in me. It shows that I am good at what I do. At the same time, I am also horrified at some of the things they have told me. I can't help it - it's a natural response.

"It's like waving your arm around in a warm room..."
"I occasionally neetta watch a video er two. Make 'em myself. 'Sbetter that way."

I can't let my horror (or amusement, as the case may be) show on my face, though. It would be most unprofessional. As such, I have managed to cultivate a facial expression that I use in this situation. It's an expression of sweetness and thoughtfulness which seems to allow other people to project their feelings on me - this way, they always come up with the reaction they are hoping to see (and find most acceptable to them). This is my 'Hello Kitty' face. I always imagine that my mouth is in a neutral position, invisible to the viewer.

" 'Course, 'salways better when she's fresh."
"I get the dog to lick it for me. 'Course, I have to get out the pate first."

But sometimes, I really, really wish that I didn't know.

Update: The 'Hello Kitty' expression is probably not suitable for amateurs - one has to have complete control over the facial muscles, especially those around the eyes and mouth.

The slightest muscle out of place, and one may appear quizzical (too much 'Pekkle') or confused (too much 'My Melody') or worse, annoyed (Too much 'Bad Badtz Maru'). This would be taken as an invitation to explain or otherwise elaborate further on their previous comment.

Ideally, one should to project an image of non-judgemental acceptance whilst discouraging unwanted eloquence on the topic being discussed.

And looking like this, is probably going a bit too far.

Medical Grand Rounds Vol 3 No 30

Grand Rounds this week is hosted by the lovely Fat Doctor.

The medical student submissions are particularly bizarre this week. Obviously, they aren't working hard enough. ;) Monash Medical Student has got a very fascinating case study (password:iamready), although it is best not read on a full stomach.

For the Kaypoh in you

I have added Twitter to my blog for all the kaypoh (busybody) people out there and for my own entertainment. Now I have something else to do when I'm bored and can't get to a computer. And I can use up all my free texts. It's a win-win situation.

Tender loving care

He does not speak or move. Sometimes, he blinks. Sometimes.

We speak to him everyday. There is no response.

We have placed stickers on his head to monitor electrical activity. The line on the monitor is flat. We yell loudly in his ear, play music and recordings of his wife's voice. The line remains flat. We tickle his chin, wiggle his eyelashes, blow air into his ear. Flat. We smack him sharply on the forehead, poke him with needles, apply pressure to his eye sockets. Still flat. Flat. Flat. Flat.

The consultants look at scans of his brain on the light boxes and talk in hushed tones. The brain looks like it is covered in big black polka dots - so many and widespread are the areas of infarcted (dead) tissue.

He is dying, we think. How long can a body last without a brain? All he does is breathe on his own and urinate and blink, sometimes.

The nurses have inserted a tube down his nose in his stomach. We try putting food and steroids down the tube - nothing happens. He does not improve. He does not deteriorate. He breathes. He urinates. He blinks, sometimes. The line on the monitor remains flat.

Eventually, we realise that feeding him through the tube is not doing anything at all - it is only making him constipated. He can only breathe and urinate, so we have to manually evacuate the bowels. It is not a pleasant job.

The doctors and nurses speak with the family. Our faces are serious and we shake our heads alot. The family cannot bear to see him like this, so silent, so still, a corpse that breathes. There is nothing we can do to make him better - they know this.

So, we stop putting food down. We give him nothing but water. Cool water, dripped slowly down the tube. He stops blinking. He is dying, we think. May it be soon.

But it isn't soon.

It takes 6 weeks.

Ozzie ozzie ozzie! (Day 4)

Evan's Lookout, Blue Mountains
Originally uploaded by Sunlight follows me.

We're having a lazy morning, the kind where you wake up with a nice long strrrrr-etch crick crick crick, tuck your arms behind your head and exhaaaaaaale. I'm lying back on a comfortable bed, in a beautiful room, and I don't have to get up. Ever.

The Walling room at Bethany Manor B&B is tastefully decorated in shades of pale green and lilac, evoking the rustic cottage gardens of Australian landscape designer, Edna Walling. A fresh white rose, petals curled to perfection, sits in a tall vase on my bedside table. The scent of it perfumes the room. I'm enveloped in a fluffy white doona (duvet? comforter? quilt?) and lying on crisp cotton sheets and I don't have to get up. Ever.

However, my grumbling belly has other plans, and I find myself sitting at in the breakfast room with a pot of tea (and a cafetiere of java for MDH), looking out into the front garden. Our host, Jill, is busy in the kitchen making up a more-than-generous breakfast - poached eggs with cracked black pepper, scrambled eggs on toast, smoked salmon with dill, fat juicy grilled sausages, buttered baby portabello mushrooms and sweet red tomatoes drizzled in olive oil, chocolate chip cookies and...MDH and I are waving our arms in protest, oh, please, stop, it's enough to feed a small army.

Gum tree
Originally uploaded by Sunlight follows me.

Bellies full to bursting, we bid farewell to lovely Jill and her husband Greg. They are kind enough to give us some advice on our trip, lending us maps and books to look at and warning us of which trails to avoid. After a leisurely waddle round the garden, we are ready to begin our scenic journey around the Blue Mountains.

The vapours released by the leaves of gum trees wraps the mountain range in a faint blue haze (hence it's name). It is this volatile essence that fuels the bushfires which plague the region every summer. This same oily mist carries with it the gloriously fresh fragance of eucalyptus. I feel as if I'm walking in an aromatherapy sauna.

Working our way along the wide trails, we are treated to grand views at every lookout point - mountains stretching away into the distance, fading into a blue sky. Overhead, tiny chirruping birds flit from tree to tree. In the distance, there is the occasional loud squawking from a passing flock of cockatoos. Striped and speckled lizards bask on rocks in the sun, scurrying away into dark holes when we approach. The gum trees creak and rustle companionably as we wander on.

Ant mounds
Originally uploaded by Sunlight follows me.

MDH and I walk carefully, trying not to disturb the multitude of ant mounds that are piled up neatly in little rows on the forest floor. Black ants march around the leaf litter, some bearing edible remnants on their backs, others sifting through the black soil and clearing the debris from their territory.

We watch in wonder as a green iridescent beetle wanders too close to the ant nest and is quickly overwhelmed by a mass of angry soldiers. It somehow manages to escape and fly off, leaving the ants snapping their mandibles in fury. The frustrated ants begin a brawl amongst themselves, eventually tumbling back into the depths of the ant mound.

MDH and I find a bench to sit on, to enjoy a snack of banana cake and leftover sausages. We sit and watch, our shadows lengthening in front of us, until it is time to head back to the city.

Ozzie ozzie ozzie! (Day 1)

No wheelies please
Originally uploaded by Sunshine follows me.

It's a bright Australian morning. The air is so heavy with humidity that it feels like being wrapped in a thick blanket. My crisp white shirt turns grey almost immediately after we step out onto the streets of Sydney.

We are headed towards Circular Quay, home of the Sydney Opera House - probably the number one tourist spot in Sydney. The harbourfront is teeming with groups of Japanese schoolkids, smiling and posing for pictures, decked out in cute striped sailor suits. MDH and I squint at each other in the sunlight like little moles - our eyes are too used to the dark, overcast english skies.

Being the respectful tourists that we are, we did not bring any skateboards, scooters or in-line skates with us during our visit.

Sydney harbour
Originally uploaded by Sunshine follows me.

MDH and I decide to take a ride on the ferry to the beach, which is a mere 40 minutes away. We've done our research online and have decided not to visit the Majestic Holy Olympic Surfing Shrine that is Bondi Beach, opting instead of the quieter, smaller bay at Manly.

The walk from the ferry terminal to the beach is through a charming row of shops and busy cafes. MDH and I stop briefly to pick up a few souvenirs - the boomerang-shaped magnets with bright Aboriginal designs of various Ozzie wildlife.

Manly Beach is beautiful and does not disappoint. The golden sands are soft and warm and one can wander barefoot into the white surf that beckons, so cool and inviting. The waves are tall enough for surfing and frolicking. Rows of tall trees grow on the promenade, providing some comfortable shade on the sand.

Bluebottle on Manly Beach
Originally uploaded by Sunshine follows me.

The area for swimmers at the beach is marked with two chequered flags - venture outside this area, and one risks a rebuke from The Loudhailers. The Loudhailers sit, tanned and muscled, on tall wooden chairs, their surfboards leaning against the trees behind them.

There are some teenagers doing backflips off the edge of the promenade onto the sands despite protests from The Loudhailers. One with a mop of blonde curls of them falls awkwardly, twisting his ankle. The Loudhailers tell him that it is his Own Damn Fault and he should not have been Playing The Fool. But they kindly carry him to the first aid station, the other teenagers following behind them, singing and cheering.

After a quick swim, I walk up and down the beach to dry off. MDH is still splashing about like a wild thing in the water. There is a sign up warning people of the presence of bluebottles on the beach, but nobody seems to care. I accidentally step on one and get a sharp sting at the base of my foot - it feels much like a papercut.

The bluebottles that have been marooned on the shore glisten like glass, their long stinging tentacle trailing behind them like a questionmark. Curious children crouch a safe distance away and prod the hapless jellyfish with sticks.

At 6pm, The Loudhailers inform us that any further sea-frolicking will take place At Your Own Damn Risk. MDH reluctantly leaves the water, sulking like a schoolboy, but he soon perks up at the promise of gelatos at the ferry terminal. But Only If He Behaves.

Fun with the elderly

Mrs C, 83, Found collapsed at home:
"Am I in hospital? Good heavens. I've only got my second best teeth in today."

Mr K, 94, Swollen right calf:
"Blood in the urine? Oh yes, I have blood in the water all the time. Isn't that normal?"

Ms F, 80, Inebriated, recurrent falls:
"I don't drink, ever. Never touched a drop in my life. Except for Guinness."

Mr P, 79, Abdominal discomfort and urinary incontinence:
"Gerroff me! Gerroff me! I'll tell on you! Gerroff!"

A visit to the dentist

It was quite uncomfortable in the chair. She was leaning as far back as she could but for some reason, the dentist couldn't get a good view of her tonsils. She tilted her head back a little bit further and made some gargling noises.

The dentist was busy peering into the depths and poking around with a sharp stick. He mumbled something about cavities and adjusted the light above her head. "Could you tilt your head back a little bit further please?"

She complied, and the dentist helped a little by applying a gentle pressure to her temples with a gloved hand. She looked up into the ceiling lights and noticed that they were flickering. Flickering on and off. On. Off. On. Off.

Then it was dark.

After a while, she managed to open her eyes again. Everything was very bright. Unbearably bright. She tried to squint but it didn't make a difference. There was a terrible pain in her left arm, and an unbearable itch on her nose. She tried to shuffle around to get more comfortable but realised that she could not move. She couldn't move anything. She tried to call out but only managed a gargling moan.

She moaned again, louder this time and tried to look around. She couldn't move her head. It seemed heavy. Was there something lying on it? She couldn't be sure. Where was the dentist? Where am I? What's going on?

She heard a bleeping sound get louder and faster and then a buzzer went off somewhere next to her ear. Suddenly, a small dark-haired person appeared in front of her vision. She appeared to be upside down and was talking Very Loudly And Slowly.

"Hello Miss Cavities. I'm TSCD. Can you hear me? If you can, blink twice."

Blink. Blink.

"You're in hospital now. You have had a stroke. You've been asleep for almost a week. Blink twice, if you understand me. Blink once if you want me to repeat what I have said."

Blink. Blink.

"The dentist brought you to hospital. Poor man had the fright of his life when you collapsed in his chair. You ruptured both the arteries supplying your brain and this caused your stroke. It is very rare that this happens, but some young women have very weak blood vessels. They can break if you tilt your head too far back, or if somebody hugs you around the neck."

Blink. Blink.

"Are you in pain?"

Blink. Blink. (gargling noise)

"I will write you up for some painkillers."

Blink. Blink.

"The doctors will see you every morning, and we will get physiotherapists and speech therapists to help you regain your strength. But it will be slow going."

Blink. Blink.

"Would you like me to leave you alone now?"

Blink. (sad gargling noises)

"Okay, I have a few minutes to spare. We can have a chat if you like."

(angry gargling noises and blinking)

"Actually, your husband was just here yesterday, and he brought you this magazine. 'Hello' Magazine, is that your favourite?"

(sad gargling noises and blinking)

"Well, he said he would visit again later today, and he'll bring your son as well. Now, let's start on this magazine shall, we? So, Kate Middleton, Prince William's arm candy, is suing the press for publishing some photos..."

Thoughts on "Amazing Grace"

1. William Pitt (otherwise known as Pitt the Younger) was a mere stripling of 23 years when he became the Prime Minister of Britain.

2. William Wilberforce founded the Society of Prevention of Cruelty to Animals (now the RSCPA), the Church Missions Society, and presented the Abolition of Slavery Act in Parliament, all before the age of 25.

3. I am 27 years old. What the heck am I doing with my life?

4. It is very interesting that William Wilberforce, after his conversion to Christianity, struggled with whether or not to remain a political activist or to become a preacherman. In the end, of course, he realised that he could best serve God by remaining where he was.

All too often, I have come across Christians who think that in order to serve God, they have to be highly involved in Church and Youth Groups or join the missionary service, neglecting their involvement in what is deemed 'secular' work (eg. schoolwork, officework).

I think that God wants His people to serve Him well in whatever discipline they are trained in. By working hard for God and bringing our Christian ideals and standards into our jobs, we can slowly bring about great changes. He wants doctors, lawyers, engineers, politicians, architects, teachers, bus drivers, cooks, cleaners, clerks, bankers, just as much as He wants church workers, pastors, preachers.

5. It is interesting to note how fast public opinion changes depending on how secure and safe people feel. Nobody cared about the plight of the slaves when there was the threat of impending revolution and bloodshed.

Grand Rounds Vol 3, No 18

Grand Rounds this week is hosted by UroStream, who was kind enough to pick my submission as Editor's Choice (yay! I can feel my head expanding already. I shall have to hire a servant to help me carry it around.).

My personal favourite is GruntDoc's post on deciding when to stop resuscitating a patient. It's a simply written post on a very difficult topic. There's also a very informative article on eating disorders written by Dr Mada.

Balconniere update

Snow on the pansies
Originally uploaded by Sunshine follows me.

It snowed occasionally but the pansies seemed to love the cold frosty weather and bloomed even more profusely than ever.

MDH would occasionally peer anxiously at the balconnieres, hoping to see some evidence of spring poking through the soil, wondering if the snow and frost had killed the dormant bulbs that he buried last autumn.

Spring is here!
Originally uploaded by Sunshine follows me.

But now that the snows have melted and the howling wind has lost it's chill, our patience has been rewarded.

Delicate, deep blue irises stand elegant and tall. Pale purple crocuses open with the warmth of the sun, revealing brilliant yellow star-centres.

MDH looks at his little growing garden and then looks at me with triumph in his eyes and suddenly, I know that he dreams about looking after little living things and cultivating little growing things.

Maybe next spring. Maybe soon.