Please find below my end-of-month review.
BOOKS
GEMMA BOVARY and TAMARA DREWE, by Posy Simmonds. Known to many through her Grauniad strips, these "graphic novels" proved a pleasurable diversion.
THE GRAFT, by RG. I am not naming the author, as he gave me a draft of his memoirs, rather than the definitive published version to read. "The graft" refers to a liver transplant he had to have, having destroyed his own through a lifetime of excess, fascinatingly chronicled by a writer of real quality. From mmy point of view, his account of prolonged insomnia is one of the best written accounts of that affliction I have ever encountered.
BLOOD MERIDIAN, by Cormac McCarthy. A band of bloodthirsty murderers are commisioned by the Mexican government to go on a scalp hunting party among the Apache Indians of the deep south-west of the north American continent. A book at once one of the most beautiful and yet most horrific ever committed to the page. I actually had nightmares.
THE GRIFTERS, by Jim Thompson. He's written a shed load of books, though this is by far the most famous, having been made into a highly successful movie with John Cusack and Angelica Huston. To be honest, as works of art (if we can compare the 2) the latter is the finer of the 2, though the book itself is eminently readable.
MUSIC FOR CHAMELEONS, by Truman Capote. A series of "factions", some of which work brilliantly, others not so well. The one about spending a "day off" with Marilyn Monroe in Manhattan is priceless, however.
FILMS
THE MILKY WAY,1969 (D- Luis Bunuel). A couple of vagrants wander along the pilgramage route to Santiago di Compostella; along the way everyone they meet is talking religion, catholic doctrine in all its contradictory complexity and folly. Funny and deeply disturbing, like all Bunuel's films, definitely to be relished.
THE LONG GOOD FRIDAY,1979 (D-John McKenzie). Made in the day when you couldn't see a new British film without Bob Hoskins in it, it shows his skills and that of the British movie scene of the late 70s to great effect.
CRAZY HEART, 2009 (D-Scott Cooper). Jeff Bridges won the oscar for his performance in this superior offering, which in some ways echos "the Wrestler" of last year; a man at the twilight of a glittering career trying to hold on to his unravelling life.
TRISTANA, 1970 (D-Luis Bunuel) Catherine Deneuve is seduced by her atheistic uncle, but gradually exacts her revenge. Always, Bunuel slams the catholic church and its hypocrisy; here he does it very subtly, as the film was made in franco's Spain and he didn't want to go to jail. The fascist idiots appeared not to notice the veiled attack, and let it go.
TWILIGHT, 2009 (D-Catherine Hardwicke). Features a "nice" vampire (all the rage, apparently) who has become a big-deal heart-throb amongST the "yoth demographic". As a film it proves quite fun, right down to the sequel which is implied almost from the outset.
ULYSSES, 1967 (D-Joseph Strick). How can you make a 2 hour movie of a 1000 pages book? Answer: you choose your scenes with great care and leave an awful lot out. Even so, the product is a success, confirmed by my wife who has not yet read the book. With only a few exceptions, I would have chosen the same scenes to portray on the screen.
LESBIAN VAMPIRE KILLERS, 2009 (D-Phil Claydon). Really, is this the best they can do? A woefully vapid offering, where the scary bits aren't scary enough, the sexy bits not sexy enough and the funny bits scarcely amusing at all. The best thing about it is the Horne/Corden pairing, which, sorry lads, isn't saying much.
Wednesday, 31 March 2010
Tuesday, 30 March 2010
confession time
With my 2 medical students in attendance, I see a patient with PMR (polymyalgia rheumatica). After she leaves, I ask what other imortant condtion is related to it and they correctly identify GCA (giant cell arteritis) When asked what the abbreviation stands for, one says "giant cell arthritis, and I gently point out how small mistakes like this can be seized on by a pedantic examiner and exploited to its limit.
Then we discuss the significance of the latter condition, where, if untreated, irretrievable blindness can result on the side affected (it's usually unilateral) And I go on to tell of one of my most catastrophic mistakes, when I missed a case of GCA (it was a slightly atypical presentation, to be fair) and the patient went blind in 1 eye. The slight problem was that he was already blind in the other eye following an industrial accident many years earlier, so I effectively blinded him completely. They look understandably horrified, as well they might..
Then we discuss the significance of the latter condition, where, if untreated, irretrievable blindness can result on the side affected (it's usually unilateral) And I go on to tell of one of my most catastrophic mistakes, when I missed a case of GCA (it was a slightly atypical presentation, to be fair) and the patient went blind in 1 eye. The slight problem was that he was already blind in the other eye following an industrial accident many years earlier, so I effectively blinded him completely. They look understandably horrified, as well they might..
Monday, 29 March 2010
blue monday
Today I visit a youngish man at home who is slowly dying of an untreatable brain tumour. Not that they haven't tried, mark you; in fact the hospital have thrown everything at him: surgery, chemo and radiotherapy, but the pressure is gradually growing inside his skull and the drugs (steroids in this case)designed to reduce the pressure aren't working any more. His speech is slow and slurred, but he is still intellectually intact. His darkest moment, he tells me, was when Edward Kennedy died recently (also of a brain tumour)
"He got diagnosed just before me, and his tumour was exactly the same kind as mine. So you can see where I'm going with this?"
I spouted some bullshit about no 2 cases being alike, but he knew I was lying.
"He got diagnosed just before me, and his tumour was exactly the same kind as mine. So you can see where I'm going with this?"
I spouted some bullshit about no 2 cases being alike, but he knew I was lying.
Sunday, 28 March 2010
tough mama
Off to see my mum today at her seaside home some 25 miles away. At 85 she remains completely independent; indeed, on a rainy, windy Friday she still played 12 holes of golf on her tricky, up-and-down course, and walking at that. Now that's what I call feisty. Yesterday we went in to John Lewis and secured her an Easter egg which we'll hand over next week when we, along with my father-in-law, will go out once again to have Sunday lunch with her. We agreed to bring a dessert. Some sort of fruit crumble is rumoured.
The weather forecasting finally "ran out of luck", as today turns out a lot more pleasant than predicted. Next week they have forecast a return to cooler conditions, with even snow falling in some parts. We shall see..
The weather forecasting finally "ran out of luck", as today turns out a lot more pleasant than predicted. Next week they have forecast a return to cooler conditions, with even snow falling in some parts. We shall see..
Saturday, 27 March 2010
It was 20 years ago today
Yes. 20 years to the very day when my wife died of breast cancer. Twenty-past seven in the evening, if you must know, after a 2 day period of lapsing slowly into unconsciousness, while developing that famous harbinger of death, "Cheyne-Stokes breathing" as it is called (look it up) She had become vividly jaundiced a few days earlier as her liver failed, and every now and then a bright yellow tear would appear at the corner of one eye...
I remember so much of even the tiniest detail of that day that it is quite extraordinary.
I remember going out to Sainsbury's at about 4 o'clock, and my brother-in-law looking at me as I was going out the front door, and saying, "I wouldn't be too long, if I were you". I wasn't, and she did in fact just 2 hours after I got back. I spent most (though not all) of those 2 hours sitting on the bed with her, sharing it with our 3 cats, all of whom were curled closely round her, as they had been for many days...
So many memories...
I remember so much of even the tiniest detail of that day that it is quite extraordinary.
I remember going out to Sainsbury's at about 4 o'clock, and my brother-in-law looking at me as I was going out the front door, and saying, "I wouldn't be too long, if I were you". I wasn't, and she did in fact just 2 hours after I got back. I spent most (though not all) of those 2 hours sitting on the bed with her, sharing it with our 3 cats, all of whom were curled closely round her, as they had been for many days...
So many memories...
Friday, 26 March 2010
beware of adulation
The weather forecasts have been remarkably accurate recently. They forecast intermittent heavy "pulses" of rain,followed by a sunny interval and have been getting it dead right now for over a week. Over the weekend they predict a better day tomorrow, (today we are enjoying a prolonged "pulse")followed by another lousy day on Sunday. We shall see how long they can keep it up..
Today a couple come in for the first time, having just changed from an adjacent practice which, they said, was staffed by doctors "who are just cold and impersonal, they just wanted to get us out of there as quickly as possible" After completing our business they both announce that I am far and away the best doctor they have ever met, "you seem genuinely interested in us as individual people", such a change from the ones they have had to put up with in the past, etc etc.
But I have seen this scenario before. Beware the patient who praises you to the skies while bad-mouthing all the others. It may not be long before you yourself are added to their hate list.
Today a couple come in for the first time, having just changed from an adjacent practice which, they said, was staffed by doctors "who are just cold and impersonal, they just wanted to get us out of there as quickly as possible" After completing our business they both announce that I am far and away the best doctor they have ever met, "you seem genuinely interested in us as individual people", such a change from the ones they have had to put up with in the past, etc etc.
But I have seen this scenario before. Beware the patient who praises you to the skies while bad-mouthing all the others. It may not be long before you yourself are added to their hate list.
Thursday, 25 March 2010
a bit of drama to get the day going
Just to show that general practice isn't just sore throats and bad backs, this morning my receptionist calls from downstairs and, demonstrating admirable sang froid, says:
"Would you like to come downstairs now, doctor; someone has collapsed"
I go down, and there he is, measuring his length on the floor, sporting a head injury he sustained in his fall to the floor. But he's conscious and alert, with a reasonable colour and quite good pulse. We gently frogmarch him in to a downstairs consulting room, put him on a couch and give him a cup of hot sweet tea. My nurse performs an ECG to check he hasn't had a heart attack, dresses his small head wound and then we let him go.
COMMENT
Earlier this week, Israel's Binyamin Natenyahu was in the USA, basically putting 2 fingers up to them and indeed much of the rest of the world which has criticised Israel for continuing to build settlements in the region of East Jerusalem under military occupation.
"Jerusalem has been an Israeli city for 3000 years" he said, "So why should we not build there now?"
Well, some might say the world has moved on a little in 3000 years, but not the Israelis. For them a story book has told them they are God's chosen people and that they have the right to behave how they choose- regardless of the rights of other peoples. East Jerusalem and the West Bank was illegally occupied (according to the UN, though nuts to them, apparently)in 1967, and ever since they have been grabbing more and more territory, creating walls higher and longer than the Berlin Wall ever was, in order to deny the Palestinian people their human rights. And still the USA, which holds the key to forcing Israel to co-operate, stands by and lets them do as they please. How much longer? Isn't it time to treat Israel like South Africa under apartheid and isolate them from the civilised world until they play fair with the Palestinian people? No brainer. Of course it is; indeed it is long overdue.
"Would you like to come downstairs now, doctor; someone has collapsed"
I go down, and there he is, measuring his length on the floor, sporting a head injury he sustained in his fall to the floor. But he's conscious and alert, with a reasonable colour and quite good pulse. We gently frogmarch him in to a downstairs consulting room, put him on a couch and give him a cup of hot sweet tea. My nurse performs an ECG to check he hasn't had a heart attack, dresses his small head wound and then we let him go.
COMMENT
Earlier this week, Israel's Binyamin Natenyahu was in the USA, basically putting 2 fingers up to them and indeed much of the rest of the world which has criticised Israel for continuing to build settlements in the region of East Jerusalem under military occupation.
"Jerusalem has been an Israeli city for 3000 years" he said, "So why should we not build there now?"
Well, some might say the world has moved on a little in 3000 years, but not the Israelis. For them a story book has told them they are God's chosen people and that they have the right to behave how they choose- regardless of the rights of other peoples. East Jerusalem and the West Bank was illegally occupied (according to the UN, though nuts to them, apparently)in 1967, and ever since they have been grabbing more and more territory, creating walls higher and longer than the Berlin Wall ever was, in order to deny the Palestinian people their human rights. And still the USA, which holds the key to forcing Israel to co-operate, stands by and lets them do as they please. How much longer? Isn't it time to treat Israel like South Africa under apartheid and isolate them from the civilised world until they play fair with the Palestinian people? No brainer. Of course it is; indeed it is long overdue.
Wednesday, 24 March 2010
big fat problem
An enormously fat young woman comes in this morning feigning incredulity at her plight. I do my best to explain that it is basically a self induced phenomenon. We have already run tests to exclude possible reasons for her gross obesity (thyroid, diabetes, etc) all of which have drawn a blank.
"But what can I do?" she bleats.
Now this lady has already irritated me by blaming all her problems on the death of her (ageing) mother some 7 years earlier. To me this is a craven cop-out and in answer to her "what can I do?" I find myself responding:
"Well, you could put less food in your mouth"
She is horrified at my insensitivity and stalks off, promising to lodge a formal complaint.
So be it.
"But what can I do?" she bleats.
Now this lady has already irritated me by blaming all her problems on the death of her (ageing) mother some 7 years earlier. To me this is a craven cop-out and in answer to her "what can I do?" I find myself responding:
"Well, you could put less food in your mouth"
She is horrified at my insensitivity and stalks off, promising to lodge a formal complaint.
So be it.
Tuesday, 23 March 2010
rainy tuesday
Got up before 10 and was able to do my "city hill walk" before the rain started coming down in stair rods, which it then proceeded to do all day.
In surgery this afternoon, which went on for over 3 1/2 hours, I mentioned to 1 patient that I was writing short stories, to which he responded that he had actually won a national competition with a story just 800 words long (my shortest is 6,500, the longest over 12,000)I would have liked to chat for longer, but the procession of "worried well" as the media (though not doctors, by the way) calls them was beginning to back up alarmingly. It is so frustrating that I have so many charming, witty and high-achieving people on my list, yet I am forever barred from knowing them any better than the 10 minutes every now and then allowed to me. I learnt a long time ago the perils of making friends of patients: it all goes OK until they get ill- then it gets all too complicated.
In surgery this afternoon, which went on for over 3 1/2 hours, I mentioned to 1 patient that I was writing short stories, to which he responded that he had actually won a national competition with a story just 800 words long (my shortest is 6,500, the longest over 12,000)I would have liked to chat for longer, but the procession of "worried well" as the media (though not doctors, by the way) calls them was beginning to back up alarmingly. It is so frustrating that I have so many charming, witty and high-achieving people on my list, yet I am forever barred from knowing them any better than the 10 minutes every now and then allowed to me. I learnt a long time ago the perils of making friends of patients: it all goes OK until they get ill- then it gets all too complicated.
Monday, 22 March 2010
death in the afternoon
This morning I am asked to see an old lady in a nursing home. She looks very frail,is uncommunicative and has a nasty grey colouring. I'm not sure exactly why, because she has presented in this way for the last several years, but I tell the staff that I fear she is dying. Three hours later they call me again to tell me she has indeed passed into another world. I go round straight away (so as to avoid going after work and delaying my return home) and there she is. I am shocked, because no matter how ill she looked this morning, she looked completely different now. A large, dark mark had appeared on her left cheek, and her colour was now a different, if anything even more ashen shade.
Sometimes people even look somehow better after they die, like my own father, who seemed 10 years younger just after he died, and he had such a good tan his colour wasn't that bad, thankfully...
Sometimes people even look somehow better after they die, like my own father, who seemed 10 years younger just after he died, and he had such a good tan his colour wasn't that bad, thankfully...
Sunday, 21 March 2010
24 hours later
This morning my wife and I set out on a mountain walk about 30 miles out of town. Not tremendously arduous, at about 6 miles with an ascent of little more than 300 metres, it is a bit special as I have seen its dark rounded shape from a distance since childhood, yet never thought to climb it until now. We would have gone yesterday, but the weather was inclement. Today, illustrating once again what a difference a day makes, it is set fair with plenty of blue sky and clouds scudding at several different layers in the atmosphere. Very pleasant.
When we return home we settle down to watch the final 2 episodes of "24", series 7. I have thus devoted 16 hours to the enterprise (and not 24, because at least a third is accounted for by commercial breaks, which thankfully we are spared in the DVD) So, was it worth the expenditure of so much time? I fear not. There is no doubt that the "24" concept, with all the action taking place in "real time", is unique and at one level both exciting and dramatic. High production values and some powerful acting performances, especially by Kiefer Sutherland, seem to make it work sticking with, but some of the plots twists are ludicrous: the president appointing her own daughter to chief of staff despite her having a dubious record (in a previous series) is just one example out of several devices that eventually made both of us lose faith. We are currently recording and storing series 8 on "sky plus", but we are both now seriously questioning whether we're going to bother. There has also been a lot of debate about "Jack's" tactic of torturing vital information out of suspects and justifying his actions as being for the greater good, saving thousands of lives etc etc, but the fact is that 24's creator, Joel Surnow, has made no secret of his republican sympathies, and one can't help wondering how much of all this is designed to support the Bush presidency and its treatment of "terrorists"
When we return home we settle down to watch the final 2 episodes of "24", series 7. I have thus devoted 16 hours to the enterprise (and not 24, because at least a third is accounted for by commercial breaks, which thankfully we are spared in the DVD) So, was it worth the expenditure of so much time? I fear not. There is no doubt that the "24" concept, with all the action taking place in "real time", is unique and at one level both exciting and dramatic. High production values and some powerful acting performances, especially by Kiefer Sutherland, seem to make it work sticking with, but some of the plots twists are ludicrous: the president appointing her own daughter to chief of staff despite her having a dubious record (in a previous series) is just one example out of several devices that eventually made both of us lose faith. We are currently recording and storing series 8 on "sky plus", but we are both now seriously questioning whether we're going to bother. There has also been a lot of debate about "Jack's" tactic of torturing vital information out of suspects and justifying his actions as being for the greater good, saving thousands of lives etc etc, but the fact is that 24's creator, Joel Surnow, has made no secret of his republican sympathies, and one can't help wondering how much of all this is designed to support the Bush presidency and its treatment of "terrorists"
Saturday, 20 March 2010
saturday lie-in
More often than not I am up and about early on Saturday, leaving my lie-in for Sundays, but I must have built up a bit of a sleep deficit and find myself not being woken by the central heating coming on and sleeping on till half-past nine. Talk about luxury! During the day I find myself going back over my hair-dryer treatment of my account manager yesterday, though my wife insists I was entitled to demonstrate my outrage in a highly assertive manner. Well, it certainly was that. He'll never forget that little conversation; I think we can be sure of that. The only thing remaining is to make sure I'll never have to see him again, though he might be so mortified he arranges that off his own bat. I should make sure though.
This evening I watch "High Noon" for the nth time. Boy, do they not make films like that any more. The power of the monochrome images, the subtle skill of Fred Zinnemann's direction. Name a better western. Go on. Can't, can you?
This evening I watch "High Noon" for the nth time. Boy, do they not make films like that any more. The power of the monochrome images, the subtle skill of Fred Zinnemann's direction. Name a better western. Go on. Can't, can you?
Friday, 19 March 2010
freakout friday
After several attempts I finally get through to my personal account manager on the phone. I had considered writing to him; I had even mulled over going straight to his superiors, but in the end there's nothing like the personal touch. I challenge him with my grievances, only to hear him say:
"After our conversation, I really thought you might be interested in knowing more" He is referring to the fact that I had questioned him briefly on the subject of original sin. "So a newborn baby is sinful is it?" I had asked, knowing the answer in advance full well. I had responded "Seems a bit unfair, somehow" and we'd more or less left it at that. Hardly a glowing endorsement of his half-assed bigotry. He keeps trying to break in to my diatribe, but I will not yield ground. He then drops himself hopelessly in it by saying he had been too busy to construct the print-out I had asked for, but I snapped back "But not too busy to write a 2 page letter and send it to my home address. Don't tell a full time GP you're too busy. And anyway, what happened to: "if you want something done ask a busy person?"
Almost bellowing by now, I leave him with an ultimatum: get the printout to me without any further delay, or I will indeed complain to his bosses (I found they do not go to the same church, thankfully)and send them a copy of the letter. I'll also ask whether they consider it appropriate to prioritise evangelical missionary work over financial advice and assistance. I don't really want to get him in serious trouble, but if he leaves me no alternative I most certainly will.
"After our conversation, I really thought you might be interested in knowing more" He is referring to the fact that I had questioned him briefly on the subject of original sin. "So a newborn baby is sinful is it?" I had asked, knowing the answer in advance full well. I had responded "Seems a bit unfair, somehow" and we'd more or less left it at that. Hardly a glowing endorsement of his half-assed bigotry. He keeps trying to break in to my diatribe, but I will not yield ground. He then drops himself hopelessly in it by saying he had been too busy to construct the print-out I had asked for, but I snapped back "But not too busy to write a 2 page letter and send it to my home address. Don't tell a full time GP you're too busy. And anyway, what happened to: "if you want something done ask a busy person?"
Almost bellowing by now, I leave him with an ultimatum: get the printout to me without any further delay, or I will indeed complain to his bosses (I found they do not go to the same church, thankfully)and send them a copy of the letter. I'll also ask whether they consider it appropriate to prioritise evangelical missionary work over financial advice and assistance. I don't really want to get him in serious trouble, but if he leaves me no alternative I most certainly will.
Thursday, 18 March 2010
god almighty
2 weeks ago I was visited in my practice by my "personal account manger" from my bank. During the conversation, it emerged that I am due to visit the Holy Land in September of this year, and he asked if I had any spiritual beliefs of my own. I was slightly cagey on this point, but he was happy to inform me he was, as the saying has it, a "born again christian", and encouraged me to visit his church one Sunday. The meeting closed with him agreeing to send me a print-out of all my accounts held at the bank (I have several)
2 weeks later I have heard nothing from him on this subject. But only 2 days after our meeting I had a personal letter from him delivered to my house, which went into some detail about the spiritual benefits of his church and urging me to take part. I now intend to write him a letter along the lines of:
"Dear Sir,
At our last meeting you promised to send me a print-out of all my investments with your bank and this is still not forthcoming. However within 2 days of our meeting you had written to me at my home regarding your christian beliefs and how my adopting them would have great benefits for my life. Some people, including perhaps your own superiors, might consider this to be a highly unprofessional way in which to conduct business, especially as your actual promise on that day has been neglected. Indeed, I have considered ccing this letter to your superiors, though if you keep to your undertaking to give me the information I asked for, and WITHOUT DELAY I shall call the matter closed.
I'm afraid I must insist, however, that you confine your future dealings with me to the ones listed on your job description.
Yours etc"
My wife thinks even this is being too gentle and that I should seriously go after him. We shall see what happens.
2 weeks later I have heard nothing from him on this subject. But only 2 days after our meeting I had a personal letter from him delivered to my house, which went into some detail about the spiritual benefits of his church and urging me to take part. I now intend to write him a letter along the lines of:
"Dear Sir,
At our last meeting you promised to send me a print-out of all my investments with your bank and this is still not forthcoming. However within 2 days of our meeting you had written to me at my home regarding your christian beliefs and how my adopting them would have great benefits for my life. Some people, including perhaps your own superiors, might consider this to be a highly unprofessional way in which to conduct business, especially as your actual promise on that day has been neglected. Indeed, I have considered ccing this letter to your superiors, though if you keep to your undertaking to give me the information I asked for, and WITHOUT DELAY I shall call the matter closed.
I'm afraid I must insist, however, that you confine your future dealings with me to the ones listed on your job description.
Yours etc"
My wife thinks even this is being too gentle and that I should seriously go after him. We shall see what happens.
Wednesday, 17 March 2010
wednesday's child
I see a small child this morning with the very unusual condition of coarctation of the aorta. In this, the baby is born with a pinching of the aorta, the principle vessel which emanates from the left ventricle of the heart and transmits oxygenated blood around the body. The pinching compromises the blood supply to the lower body, and if untreated usually leads to death in childhood. Fortunately, now an operation can entirely correct the problem, which is often diagnosed by the absence of femoral pulses in the infant.
The operation is coming soon, much to mum's relief, though she does mention the delays caused in reaching the diagnosis by almost everyone initially missing the fact that the femoral pulses were absent. I nod in agreement and check my notes. I examined the baby myself at the routine 8 week check, and passed it as normal. That is, I missed it too. I come clean, admitting that I appear to have missed it myself. She is not cross with me, but with the more expert paediatric cardiologists who also failed to spot it. Which fails to make me feel any better. I usually look for the femoral pulses very carefully, but I clearly failed this time. It doesn't make me feel good, I have to say.
The operation is coming soon, much to mum's relief, though she does mention the delays caused in reaching the diagnosis by almost everyone initially missing the fact that the femoral pulses were absent. I nod in agreement and check my notes. I examined the baby myself at the routine 8 week check, and passed it as normal. That is, I missed it too. I come clean, admitting that I appear to have missed it myself. She is not cross with me, but with the more expert paediatric cardiologists who also failed to spot it. Which fails to make me feel any better. I usually look for the femoral pulses very carefully, but I clearly failed this time. It doesn't make me feel good, I have to say.
Tuesday, 16 March 2010
2 billion
is what unnecessary calls to the GP cost the NHS every year, according to a report published today. And every GP will agree with me when I say I see 6 or 7 people every day who don't need to be there. They are not malingerers: sometimes they are afraid, but just as often they form part of a group for whom any deviation of health is unacceptable. They don't understand that colds, and their attendant symptoms of sore throat, nasal congestion and headache ARE acceptable deviations of health, and that human beings everywhere experience and recover from them in a few days.
We should take a leaf out of the book of the chronically and seriously ill, most of whom endure much worse things and for much longer, yet still many of them continue to lead their lives to their best ability.
We should take a leaf out of the book of the chronically and seriously ill, most of whom endure much worse things and for much longer, yet still many of them continue to lead their lives to their best ability.
Monday, 15 March 2010
easy monday
A pleasant day in surgery, with no real problems (that usually translates as someone being unpleasant to me for whatever reason)
I did see one man, a long established schizophrenic who is brought by his dad, who tells me that his current medication regime isn't working out for him. He spends part of each day leaning out of his window hurling nonsensical abuse at neighbours and other equally surprised passers-by, so I give him a reality check, warning him that people who live in a crowded community shouldn't upset their neighbours and that there could be dire consequences of behaving in this manner, police being called, angry victims coming to the house with the purpose of giving him a good hiding, etc etc.
I also increased the sedative component of his regime, which is probably going to be more effective. He seemed to take my advice on board at the time, but I know perfectly well that psychotics don't usually respond to rational argument. But you've got to try...
I did see one man, a long established schizophrenic who is brought by his dad, who tells me that his current medication regime isn't working out for him. He spends part of each day leaning out of his window hurling nonsensical abuse at neighbours and other equally surprised passers-by, so I give him a reality check, warning him that people who live in a crowded community shouldn't upset their neighbours and that there could be dire consequences of behaving in this manner, police being called, angry victims coming to the house with the purpose of giving him a good hiding, etc etc.
I also increased the sedative component of his regime, which is probably going to be more effective. He seemed to take my advice on board at the time, but I know perfectly well that psychotics don't usually respond to rational argument. But you've got to try...
Sunday, 14 March 2010
a mother of a sunday
Today we have a meal in honour of mother's day in a noted fish restaurant outside town. In addition to my mum we have brought along my wife's dad for the ride. The poor bugger's facilities are fading before one's very eyes, but even so he manages to comport himself in a perfectly appropriate manner, though some of his "little ways", like continually drumming on the table with his fingers, I do find a tad irritating.
This afternoon we reached the half way point in series 7 of "24". We ration ourselves to just 2 episodes per day, as we have found in the past with other series, too many episodes in one day can bring on a kind of madness. I'll have more to say on "24" when we've finished watching it.
This afternoon we reached the half way point in series 7 of "24". We ration ourselves to just 2 episodes per day, as we have found in the past with other series, too many episodes in one day can bring on a kind of madness. I'll have more to say on "24" when we've finished watching it.
Saturday, 13 March 2010
saturn's day fun
I will confess to blogging whilst under the influence, faintly intoxicated one might say. Is that OK as regards the etiquette of the blogging fraternity? Or are they "on" all the time?
Whatever, an interesting and varied day. In half-hour chunks I have put in about two hours work on the first "read through" of my latest story. Only a couple more hours, then I can show it to my wife for her to give me her particular finely-honed analysis. It's always a nervous moment for me, as she has not been above advising me to re-work altogether.
This afternoon I drive out into the country to see an old friend who, according to "sources close to her" is going through a tough time. I just want to be there, show my solidarity, as it were, for a fellow sufferer of life's hand of cards.
The light is beautiful, clear skies becoming golden in the late afternoon. I took a few pictures, some of which have turned out quite well. Oh, don't worry, by the way. I haven't hit a delete button since the fateful event, intoxicated or otherwise.
Whatever, an interesting and varied day. In half-hour chunks I have put in about two hours work on the first "read through" of my latest story. Only a couple more hours, then I can show it to my wife for her to give me her particular finely-honed analysis. It's always a nervous moment for me, as she has not been above advising me to re-work altogether.
This afternoon I drive out into the country to see an old friend who, according to "sources close to her" is going through a tough time. I just want to be there, show my solidarity, as it were, for a fellow sufferer of life's hand of cards.
The light is beautiful, clear skies becoming golden in the late afternoon. I took a few pictures, some of which have turned out quite well. Oh, don't worry, by the way. I haven't hit a delete button since the fateful event, intoxicated or otherwise.
Friday, 12 March 2010
good friday
The last day for my student. They stay for 2 weeks at a time, and usually there are 2 of them. For some reason this one was a singleton, which is actually a lot less stressful. I check his current events and cultural knowledge as I tend to on the last day, as I think it's important that doctors are in touch and have a reasonably broad cultural base. Some of them, however, are appallingly lapse in either or both of these areas, but this lad is above average, not only academically but also in these broader fields. I sign his attendance sheet (his was perfect)but am unable to grade him, as the examiners are keener on knowing whether they have turned up than how good they are when they get here.
This afternoon I have a coffee with an old friend whose wife is very ill with myeloma. This is a kind of gratis counselling session, but I don't mind: he's one of my oldest friends and really needs this form of support. Midway through our conversation at a Coffee #1 outlet a young man comes over to our table and, clipboard in hand, asks if he can speak to us for a few minutes. In unison we both say "Actually, no, sorry" I can honestly say I have never seen anyone look quite so crestfallen at being rejected as he did at that moment. He retreated to his own table and sat there enshrouded in a pall of gloom for many minutes before getting up to leave.
This afternoon I have a coffee with an old friend whose wife is very ill with myeloma. This is a kind of gratis counselling session, but I don't mind: he's one of my oldest friends and really needs this form of support. Midway through our conversation at a Coffee #1 outlet a young man comes over to our table and, clipboard in hand, asks if he can speak to us for a few minutes. In unison we both say "Actually, no, sorry" I can honestly say I have never seen anyone look quite so crestfallen at being rejected as he did at that moment. He retreated to his own table and sat there enshrouded in a pall of gloom for many minutes before getting up to leave.
Thursday, 11 March 2010
under pressure
weighing down on me, under pressure.. as the song goes. And that describes the feeling today pretty well. All the patients seem to have difficult to understand, even harder to solve, problems. Patients where I've already tried everything I could think of, including hospital referral, yet they're still not right, and what am I going to do about it? Somehow I get through to the end without losing my cool, but then I have to run several audits in order to qualify for certain types of remuneration. Name after name after name must be typed in and their notes scrutinised- but I shouldn't complain: my partners do even more of this work than I do and it doesn't seem to bother them.
I can't wait to get home and entrench myself on my security sofa, where my wife will sustain me and allay my all pervading sense of fear. It helps, as always, but only to a limited extent. A very difficult day.
I can't wait to get home and entrench myself on my security sofa, where my wife will sustain me and allay my all pervading sense of fear. It helps, as always, but only to a limited extent. A very difficult day.
Wednesday, 10 March 2010
a fat lot of use
A young woman comes today asking to be referred for a gastric banding procedure. Other patients have had this in the past, but she is the first to ask to have it performed under the auspices of the NHS. Her grounds seem good though; she is 5'3" tall and weighs, wait for it, 27 stone or about 165 Kg. Which means I am 6" taller than her, but weigh less than half what she does. In fact I always worry she is going to collapse my consulting room chair when she plumps down on it. It hasn't happened so far, which is a remarkable tribute to its robust design. I think the NHS will play ball; she easily meets their criteria. But isn't this procedure a bit like getting a smoker to stop by taping their fingers together so they can't pick up their cigarette? Shouldn't I be addressing why she eats for four when she should be eating for one?
This afternoon's baby clinic is busy, but manageable. My nurse has, thankfully, re-surfaced, heavily made up and adorned with skin-toned band-aids to cover the injuries. Fell over a goat, apparently...
This afternoon's baby clinic is busy, but manageable. My nurse has, thankfully, re-surfaced, heavily made up and adorned with skin-toned band-aids to cover the injuries. Fell over a goat, apparently...
Tuesday, 9 March 2010
the golden statistic
Up early to re-bag my rubbish, which had been opened in the night (my neighbour's too; I was not singled out)and its contents strewn all over the pavement. One of my more indigent neighbours, I can only presume.
Then off to our local baker to purchase a large granary loaf (non-organic; they're too heavy) followed by a very satisfying 1 hour walk on a nearby hillside in pleasant conditions. When we have high pressure over Britain, they often get it in the neck in France and Spain, both have which have endured unseasonal snowstorms, while we bask in Spring sunshine.
In the afternoon, I explain to the student (and illustrate it with a profusion of examples) what I call "the golden statistic". This, and research has proved its validity more than once, is the fact that 90% of problems brought to a GP will clear up within 2 weeks, even if the doctor doesn't do anything. The tension comes, of course, with the remaining 10%. And that's a very different story...
Then off to our local baker to purchase a large granary loaf (non-organic; they're too heavy) followed by a very satisfying 1 hour walk on a nearby hillside in pleasant conditions. When we have high pressure over Britain, they often get it in the neck in France and Spain, both have which have endured unseasonal snowstorms, while we bask in Spring sunshine.
In the afternoon, I explain to the student (and illustrate it with a profusion of examples) what I call "the golden statistic". This, and research has proved its validity more than once, is the fact that 90% of problems brought to a GP will clear up within 2 weeks, even if the doctor doesn't do anything. The tension comes, of course, with the remaining 10%. And that's a very different story...
Monday, 8 March 2010
blue monday
My nurse no show today; apparently there was an accident at her farm and she herself is nursing a black eye and other injuries. It is only a minor irritation today, but if she doesn't show on Wednesday I'll have to do the baby clinic by myself again (see blog for 3 Wednesdays ago), and frankly I'm dreading that.
COMMENT
I hear this morning on Al Jazeera that water levels in the Mekong River have fallen to almost unprecedented levels, threatening the economies, and indeed the very lives of millions of people who live in Thailand, Laos and Vietnam. Even allowing for low rainfall recently, a water level change of 30 whole centimetres was seen yesterday in Thailand, and that can only be due to the dams, no less than 4 of them, that China have erected on the river, all this without the slightest degree of consultation with her neighbours who are directly affected.
Where do the Chinese get off with this sort of "Everybody else go screw, we've got our agenda and we're sticking to it" attitude. They pump CO2 into the atmosphere like it's going out of fashion, there's not even a semblance of civil rights- remember they do not allow twitter, you tube or facebook to be accessed within their borders, yet we fall over ourselves to do business with them, because it's good for our economies. In reality we're just buying into this freedom-hating state.
COMMENT
I hear this morning on Al Jazeera that water levels in the Mekong River have fallen to almost unprecedented levels, threatening the economies, and indeed the very lives of millions of people who live in Thailand, Laos and Vietnam. Even allowing for low rainfall recently, a water level change of 30 whole centimetres was seen yesterday in Thailand, and that can only be due to the dams, no less than 4 of them, that China have erected on the river, all this without the slightest degree of consultation with her neighbours who are directly affected.
Where do the Chinese get off with this sort of "Everybody else go screw, we've got our agenda and we're sticking to it" attitude. They pump CO2 into the atmosphere like it's going out of fashion, there's not even a semblance of civil rights- remember they do not allow twitter, you tube or facebook to be accessed within their borders, yet we fall over ourselves to do business with them, because it's good for our economies. In reality we're just buying into this freedom-hating state.
Sunday, 7 March 2010
nice quiet day
I try to avoid saying "I deserved that", because in general it's a redundant concept: human beings don't deserve anything- equal rights, justice, freedom, etc. If they want these things they have to go out and fight for them, then struggle even more to keep them. So I don't "deserve" a quiet day like today, with nothing to be done but making the odd meal, washing it up and putting it away again. I'm just glad I had one. In less than a month work begins on my kitchen and there'll be no quiet days, Sunday or otherwise, for quite a while, I fear.
My chest infection is easing, thanks to the ABs, God bless 'em. In the pre-antibiotic era I could have been in a much worse state today; over the years they may even have saved my life once or twice.
My chest infection is easing, thanks to the ABs, God bless 'em. In the pre-antibiotic era I could have been in a much worse state today; over the years they may even have saved my life once or twice.
Saturday, 6 March 2010
saturday night live
At 11.55 PM I am in just under the wire for making my daily deadline.
An ambitious project, said a friend when I told him I was going to keep a daily journal for a whole year. But I have some experience, and am daily inspired by the greatest diarist of them all, Samuel Pepys, who kept a daily diary for almost 10 years and maintained an incomparably high standard of writing throughout.
Today has been exactly the stress free day to kick back and indulge myself that I needed so badly. I finished the first draft of my new story today. Within a fortnight I will have completed the revision process. I feel good about it; whether anyone else will is another story.
This evening, sharing a bottle of Alain Navarre rose champagne with 2 of our oldest and dearest friends- a delightful little soiree.
I find I posted my original blog just after midnight. Please forgive my laxness. I'm sure Pepys would.
An ambitious project, said a friend when I told him I was going to keep a daily journal for a whole year. But I have some experience, and am daily inspired by the greatest diarist of them all, Samuel Pepys, who kept a daily diary for almost 10 years and maintained an incomparably high standard of writing throughout.
Today has been exactly the stress free day to kick back and indulge myself that I needed so badly. I finished the first draft of my new story today. Within a fortnight I will have completed the revision process. I feel good about it; whether anyone else will is another story.
This evening, sharing a bottle of Alain Navarre rose champagne with 2 of our oldest and dearest friends- a delightful little soiree.
I find I posted my original blog just after midnight. Please forgive my laxness. I'm sure Pepys would.
Friday, 5 March 2010
the burden of command
Probably should have stayed home today. Half way through surgery i went into a spasm of coughing and hawking right in front of the patient and student. The former took it in his stride; the latter, spied out of the corner of my eye, stared goggle-eyed in horror as I spluttered fit to burst. It took a good couple of minutes to regain my composure.
At lunchtime, over sandwiches of such gargantuan proportions they could have fed half Port-au-Prince for a week, the bi-monthly practice meeting of partners and practice manager. She has her usual list of things-that-must-be-done, re-decorating, new blinds, replacing the carpet in the waiting room (it gets an immense amount of wear, it must be said)replacing the phone system (it is over 15 years old)with one of those where a voice gives you a list of options: I hate them but there's no denying it liberates the receptionists for other duties, and so on almost endlessly, to the point where the responsibility weighed on me with such crushing force I simply wanted to run away and seek the security of my well loved, and well used, sofa.
But with my chest in its current condition I wouldn't have got very far. I am so looking forward to my retirement next year. I know I will no longer be the captain of the ship, but right now the prospect of simply being a part-time assistant seems awfully attractive.
At lunchtime, over sandwiches of such gargantuan proportions they could have fed half Port-au-Prince for a week, the bi-monthly practice meeting of partners and practice manager. She has her usual list of things-that-must-be-done, re-decorating, new blinds, replacing the carpet in the waiting room (it gets an immense amount of wear, it must be said)replacing the phone system (it is over 15 years old)with one of those where a voice gives you a list of options: I hate them but there's no denying it liberates the receptionists for other duties, and so on almost endlessly, to the point where the responsibility weighed on me with such crushing force I simply wanted to run away and seek the security of my well loved, and well used, sofa.
But with my chest in its current condition I wouldn't have got very far. I am so looking forward to my retirement next year. I know I will no longer be the captain of the ship, but right now the prospect of simply being a part-time assistant seems awfully attractive.
Thursday, 4 March 2010
unanswered calls
Just 2 days ago I indicated that I always take calls from other doctors, but today I find not all my colleagues take the same view. I try to ring the rheumatologists to arrange an urgent appointment for a patient with multiple joint swellings and some very worrying blood results, only to be told that "the doctors are not to be interrupted during clinic" Where do they come off with a precious and arrogant attitude like this? Put another way: who the hell do they think they are? I try for nearly two hours before finally being connected to one, who, on hearing the facts makes arrangements to see the patient immediately. When I confront the doctor about the "non-interruption" policy she feigns ignorance of the rule. Neat, huh?
The whole situation has not been eased by my having developed a nasty cold, which, as is usual in life-long smokers, has turned straightway into a chest infection. I almost wish I'd stayed home today, but one of my receptionists is also streaming, and she's come in, so I have to set a good example.
The whole situation has not been eased by my having developed a nasty cold, which, as is usual in life-long smokers, has turned straightway into a chest infection. I almost wish I'd stayed home today, but one of my receptionists is also streaming, and she's come in, so I have to set a good example.
Wednesday, 3 March 2010
memories are made of this
This morning in surgery I speak to a man who has lived in our town all his life. I ask him how much he remembers of the war. Quite a lot, it would seem. His memory is of an immensely happy and exciting time, except for the rationing, which he found annoying, especially because you could never get any more than the tiniest slivers of chocolate .
He told me of one extraordinary night in 1941 when there was an air raid. His family eschewed the shelters, preferring to take their chances in their own home. His grandmother had situated herself in a doorway, believing this to be the safest place in the house, seated in her beloved rocking chair, while the front and back doors were wedged open "to let the blast through the house without damaging it", apparently. Then a landmine had fallen in the back garden, and blown grannie straight out of the front door. When the dust settled, she was found on the other side of the road, unharmed and still sitting in her rocking chair which had been blown out with her.
Now that's what I call a war story.
He told me of one extraordinary night in 1941 when there was an air raid. His family eschewed the shelters, preferring to take their chances in their own home. His grandmother had situated herself in a doorway, believing this to be the safest place in the house, seated in her beloved rocking chair, while the front and back doors were wedged open "to let the blast through the house without damaging it", apparently. Then a landmine had fallen in the back garden, and blown grannie straight out of the front door. When the dust settled, she was found on the other side of the road, unharmed and still sitting in her rocking chair which had been blown out with her.
Now that's what I call a war story.
Tuesday, 2 March 2010
a taste of spring
My morning off, and I drive just outside town to climb a small hill. Conditions are as favourable as they have been for 4 months; at 10 degrees it is definitely the warmest day of the year.
For lunch I enjoy herring in dill cream sauce courtesy of Lidls. Mm.. lovely stuff!
I am interrupted midway through afternoon surgery by a doctor calling. I always take calls from doctors straight away, perhaps in the hope I will always be afforded the same privilege (I am not, by the way).
"This is Dr--, chief executive of the PCT disciplinary committee"
I quail for a moment. What have I done now? I think. But no, it is not about me, but about another member of staff they have just fired.
"We just thought you should be aware, as he's your patient, that some of the committee were rather concerned about his mental health when he left the tribunal"
Now I see. So they've sacked him, he isn't too pleased about it, so just in case he goes home and offs himself, at least they'll be able to enter into their records the fact that they informed the GP of their concerns. Cynical bastards.
"Do you want me to do anything?" I ask.
"No, just so you know what's happening"
I make the relevant entry in his notes, leave myself a note to mention it to my partners and leave it at that.
PS- I have heard nothing amiss regarding the bloke with what the students thought could have been a pulmonary embolism. I therefore assume he is still alive- and well.
PPS- nothing further about the complaint yet, either. But it is early days: complainants can go to ground for weeks before launching their next salvo.
For lunch I enjoy herring in dill cream sauce courtesy of Lidls. Mm.. lovely stuff!
I am interrupted midway through afternoon surgery by a doctor calling. I always take calls from doctors straight away, perhaps in the hope I will always be afforded the same privilege (I am not, by the way).
"This is Dr--, chief executive of the PCT disciplinary committee"
I quail for a moment. What have I done now? I think. But no, it is not about me, but about another member of staff they have just fired.
"We just thought you should be aware, as he's your patient, that some of the committee were rather concerned about his mental health when he left the tribunal"
Now I see. So they've sacked him, he isn't too pleased about it, so just in case he goes home and offs himself, at least they'll be able to enter into their records the fact that they informed the GP of their concerns. Cynical bastards.
"Do you want me to do anything?" I ask.
"No, just so you know what's happening"
I make the relevant entry in his notes, leave myself a note to mention it to my partners and leave it at that.
PS- I have heard nothing amiss regarding the bloke with what the students thought could have been a pulmonary embolism. I therefore assume he is still alive- and well.
PPS- nothing further about the complaint yet, either. But it is early days: complainants can go to ground for weeks before launching their next salvo.
Monday, 1 March 2010
optional relief
After leaving things for nearly 3 weeks, I phoned to arrange an appointment to see my orthopod again regarding my shoulder injury. However, when I arrived home this evening there was a letter from him waiting for me. I quote the relevant passages:
"...Your MRI shows some degenerative change (that's osteoarthritis to you and, it seems, me) and a low grade capsulitis, which probably accounts for the discomfort you are experiencing... there is no surgical target here (sic) and I have duly referred you for physiotherapy..."
Which is good, I suppose. No need for an operation, as it will probably get better by itself given a handful of months. Personally I have never had much faith in the merits of physiotherapy; all I need is some pointers as to the best moves to make in order to enhance my range of movement, then they can leave me to my own devices. At present it does not cause me that much trouble, though it is uncomfortable to sleep on my right side, and I keep forgetting and making movements that do hurt quite a lot. But that's my fault for being so stupid, as is the whole thing, as I have explained in a previous blog. But the signs for the medium term are favourable.
"...Your MRI shows some degenerative change (that's osteoarthritis to you and, it seems, me) and a low grade capsulitis, which probably accounts for the discomfort you are experiencing... there is no surgical target here (sic) and I have duly referred you for physiotherapy..."
Which is good, I suppose. No need for an operation, as it will probably get better by itself given a handful of months. Personally I have never had much faith in the merits of physiotherapy; all I need is some pointers as to the best moves to make in order to enhance my range of movement, then they can leave me to my own devices. At present it does not cause me that much trouble, though it is uncomfortable to sleep on my right side, and I keep forgetting and making movements that do hurt quite a lot. But that's my fault for being so stupid, as is the whole thing, as I have explained in a previous blog. But the signs for the medium term are favourable.
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