I’ll be offline until a week tomorrow

I’m moving into the new house tomorrow, and my internet connection will follow on Saturday. Sorry about the dearth of postings.

What if?

One of the things I find difficult about respiratory is the shear mortality rate. Whilst I’m at work I’m busy, I just get on with it and most people die. This is depressing but at the time I just get on with it, I can take a break, chat with nurses, think about other things, I cope quite well.

As soon as I get home and relax I start to get haunted by my memories, and above all ‘could I have done things differently’ should I have done something to prevent it, could I have done something to prevent it?

I only really relax when I’m at work and can see all my charges and see that they’re ok.

I’m not sure I can carry on with this job.

Of course I will carry on – I have a mortgage I have no other saleable skills. If I was renting a room I’m not sure I would carry on. I’m I’m not a doctor I’m an typist, that’s the only other work I’ve ever done. Or Healthcare Assistant work, or office work, but not skilled work.

I’m fairly sure I would carry on. I think this is just a difficult phase.

Christmas in Respiratory Medicine.

Everything I do is through a window of tinsel at this time of year. Most of our patients are aware of the fact that this is likely to be their last Christmas. Some of them are unconscious. A few of them will survive if they make it through their pneumonia. Corners are cut to get people home in time.

There’s the fact that do you break bad news before or after Christmas? Do you tell them that the biopsy you are proposing to do is to find out if they have cancer and you can’t for the life of you think that anything else could cause those symptoms? Or do you decide that you might let them have one more relaxed Christmas? Or just one more Christmas?

Then there’s the fact that the hospital is haunted by hosts of Santa-hat-wearing-bell-ringing-volunteers who turn up on the ward to cheer the patients up by singing carols.

“We’re a little concerned that there’s a bit more than infection here, I think we need to do a few more tests”

“Could it be serious Doctor?”

“We wish you a Merry Christmas, we wish you a Merry Christmas’

People pray for the unfortunate people who have to be in hospital at Christmas – well they did at midnight mass last night, I have to admit I quite like being prayed for. Though frankly they ought to pray for the ones we recently sent home because they wanted to spend Christmas with their family. As well as those who aren’t fit to go which do, we have those that fit to go which don’t because they don’t have anyone to spend Christmas with.

I wondered if it was possible to send the patients who are well enough but don’t have a family home with those families who want their grandmother home for Christmas despite the fact she’s seriously unwell?

‘No you can’t have your grandmother – but why not have this one instead?’

The children’s wards in particular are full of gifts donated by sympathetic charities. I expect there’s a mental image of a Victorian Nightingale Ward full of poor children who are dying of typhoid. Have you been on a children’s ward recently? The first thing you notice is the large murals of colourful cartoons, the second thing is the sheer amount of toys. You see the parents of sick children buy them huge amounts of toys, and not all sick children are poor and deprived. There are those that are of course, but they generally get to play with the chairitable donations.

Do you know the amount of secondary gain children get from being unwell? Faking illness in order to gain sympathy is a serious problem on children’s wards.

Mind you no one donates to our wards -

Any one want to donate a gift for those who are dying slowly of self inflicted illness? They’d quite like a packet of fags, and if you want to be charitable you could wheel them outside for one’

But I’m off today! Woohoo, tomorrow is time to clear up the mess that happens with a day of inadequate medical cover.

Another coming out…

I’ve recently being buying a house, and thanks to interest rates it’s all a bit more expensive than it was the last time I did it. So I was looking for a lodger. My friend H, who has been in my study group is currently getting sick of her landlady, and her own house purchase seems to have fallen through. So it was proposed that she could move in with me. This is good. For one thing she is good company, interesting, vegetarian, likes my cooking, and is offering to give me money. These are all good traits. Especially giving me money. I do like money. Esp when I have so much debt.

Now this is a small problem. She doesn’t know I’m trans. She did know I’m on testosterone, she found the packet in the bathroom when we were studying once. I said that I had a primary androgen deficiency. She couldn’t quite work it out, because I didn’t fit with any primary androgen deficiency she knew of, but she just assumed she was stupid. Which she isn’t by the way.

If she lived with me there was probably a high chance she’d find out, and I didn’t want to have to rip the page I’d written my name in out of every book I brought before 2001. Also she was quite uncomfortable living with her current housemate who has recently got a new boyfriend, and is spending a lot time snogging him on the sofa.  If she was going to freak out when she found out I’d rather it was now as opposed to when we were living together.

She was fine about it – interested – she needed to ask lots of questions to fit it into her world view. I never thought I’d be living with a Christian – though she’s C of E rather than scary born again type. But it seems I will be entering the great new world of house sharing again. After three years of being able to wander around without getting dressed, and not do very much housework. (Or indeed any!) I’m now re-entering the world of ‘is it your turn to clean the bathroom’ and ‘can I borrow half an onion’.

Still it’s probably going to be the only flatshare with a rent that includes ‘All Bills, a wireless internet connection, half an organic veg box a week, and a subscription to New Scientist, New England Journal of Medicine, and the BMJ’

Sometimes I don’t want this job

Sometimes I don’t want the responsiblity, I don’t want the death, I don’t want the misery and the tears.

Sometimes I keep going for the mortgage.

Today was one of those days.

Sample questions from the MRCP (Real Life Section)

1. You have had causal sex with a Staff Nurse who works on your ward. She is of Nigerian Extraction, but has never left the UK apart from to go on a French exchange when she was a teenager. You are concerned you may have contracted an Sexually Transmitted Infection (STI).

 Which of the following do you ask your friend to prescribe?

a) - Amoxycillin

b) Metronidazole

c) Azithromycin and Doxycycline

d) Ciprofloxacin and Amoxycillin

e) Augmentin

2. A 72 year old woman is admitted short of breath. She is unable to give a history, but the X Ray looks a bit fluffy. What do you prescibe?

a) Frusemide

b) Neubulizers

c) Limited flow Oxygen

d) 2g Ceftriaxone IV

e) All of the above – (Co-amoxy-geri-fuse)

3. It is 2am, you are in a pub with your House Officer. She is clearly intoxicated. When you get back to the hospital accomodation in which you both live what is your first course of action.

a) Put her to bed and tell your Consultant she has an alcohol problem.

b) Put her to bed and join her there.

c) 1000mls of Normal (0.9%) Saline (iv), over 4 hours.

d) 50m Cyclizine IV.

e) D, C and B (in that order).

Medical Ethics – by Nanny Ogg

There is a scene in a certain Prattchett book where Nanny Ogg is delivering a baby – she has to decide whether to save the life of the mother or the baby. The Junior witch asks if she should ask the father which to save – Nanny Ogg replies:

What’s he done to deserve that choice

She’s right though. No man deserves to have the responsibility to make that choice. And fortunately the days when obstetricians had to make the decision to save the mother or the baby are long gone.

But we still give people unacceptable responsibility. In the UK the decision when to stop treatment is a medical one. When it gets to the point where the suffering caused by the treatment – eg me trying 14 times to get a new cannula in – would probably outweigh the likely benefit, then it’s time to reconsider the treatment. Of course you ask the opinion of the patient – but they’re usually too ill. So you ask their family what their opinions would be likely to be. You take into account what sort of quality of life they have.

Do we consider the impact this discussion has on the family? I’ve meet lots of people who think that the decision ‘whether or not to resuscitate their relative’ was the hardest decision they ever had to make. Which is a tragedy because it wasn’t their decision at all.

There’s always the nagging doubt that if they had insisted that she should be resuscitated – then she would still be with us. They wouldn’t have understood how horrible a resuscitation attempt would have been, and that it would have inevitably failed.

No one deserves that sort of guilt.

Respiratory Medicine – first breathes

I’ve been on loan to Respiratory Medicine before, and I didn’t really like it much. It was soul destroying – there was so little we could do.I didn’t get off to a good start, I turned up on Friday morning – and started seeing my patients – so far so good, until it became established that I ought to have been in clinic. So far we have My Boss – who is very organised and likes to have things Done Correctly. He’s very through. The Last Boss was very laid back, oddly enough both there patients tended to get better. This is the first time I’ve worked for a Consultant I’ve been scared of.

We have The Reg, who is very keen. He’s one of those people who does everything right, he doesn’t cut corners and he doesn’t avoid work. He isn’t that experienced in Respiratory – but that doesn’t matter too much. He’s always there when I need him. Some people have the basic premise in life to avoid as much work as possible, the Reg has the mission to Do Things Right.

I first met him when one of my colleagues patients ‘went off’ we couldn’t get hold of a Reg, but he was the Reg On Call so we called him in desparation, he came up, even though it wasn’t really his job. There wasn’t a nurse available, and he didn’t make a fuss at all, he did every single thing himself, passed a catheter, did the Obs, took bloods arranged ITU admission.

And we have the House Plant, (HP) She’s lovely, shy, very quite and very scared. She qualified in India quite recently, and came over here to join her husband. She’s not worked for over a year (PLAB exam and looking for a job) Somewhere under her nerves there’s a doctor, I just wish I could find it. I just feel immensely sorry for her. It’s not really any less work, and sometimes it would be quicker to just do the work myself, but she’ll be on her own soon, and I don’t think she’ll cope.

My first attempt at MRCP Part 2 (written)

Actually taking the exam starting on Tuesday – when I arrived in the City I used to live in. There are closer exam centres to Hospitaltown-on-sea, but it’s a two day exam, and I’d have to stay over. Ok. I’m just missing the City and I’m missing my friends.

I had a lovely trip, I miss the city and it was great to catch up with my friends. Esp my friend Sieanna* who I stayed with. Like me she was raised by hippies – now she’s an accountant – but to be honest we both rebelled. She’s got a lovely son (5) I got quite broody reading him a bed time story.

Anyway The Exam.

Same hall as Part 1.

Different questions – each paper 100 questions and three hours. I finished quite comfortably fortunately. But a good proportion of the times I had no idea what was going on. I don’t think I passed to be honest.

This is annoying because I’ve always truly believed that I could have anything I wanted if I worked hard. I really wanted to pass this exam and I did work hard. Maybe I’m just too thick to be MRCP.

I’m now back home, and I’m trying to work out what to do. I start my new job tomorrow and ought to clean my flat, I haven’t really cleaned for a while and it’s vile unhygienic pit of hell. I brought a new book on the way home ‘The Ancestors Tale’ by Richard Dawkins. I love Richard Dawkins – especially his writing on biology. It’s great reading something that isn’t about medicine.

On the plus side (or maybe the minus) I am completing on the house I’m buying next week. This is exciting, but a bit scarey as house prices have crashed. I may well be in negative equity soon.

*not her real name.

lets see if this works

I’m on my mobile phone waiting to go into the exam. Trying to avoid other people because i don’t want to get dissprited. Experience has taught me that how i thought i did in an exam bears little relation to the mark. And i am very experienced at taking exams.