New mental illness discovered

I would like to report that I discovered a new mental illness that I shall call "Mature-type-onset Tourette's syndrome".

It appears to be Intermittent in presentation,and indeed,frequently,appears to be externally-driven or situationally-triggered.

It has been extensively reported in ER Units by staff who apparently,on interaction with patients, -and particularly on night duty-,find themselves inexplicably swearing,cursing,'taking-of-the-Lords-name-in-vain' or smacking of the forehead whilst uttering the phrase "what the hell was I thinking when I took this job!!"

There is an apparent subset of the disease,which appears to be motivated by interaction with Hospital management,and in particular,with so-called 'bed-managers'.

The cure appears to be either copious amounts of alcohol or several bars of chocolate per day.
Or you can blog.

Fashion Police

FASHION * POLICE

FIXED PENALTY NOTICE

CHARGE - "MUTTON-DRESSED-AS-LAMB"

Dear Ann Teak

I write to you following a complaint from a member of the public regarding your attendance at the Minor Injury Unit yesterday.

I have to advise you ,that whilst the major winter-2008 fashion style for women is a black mini-skirt (which may be pleated) with dark tights/pantyhose/stockings/leggings,that this fashion really only applies to women under the age of 21.

In exceptional circumstances and specifically for the "festive season",this age may be raised to 25.

In no circumstances however may the circumference of the combined thighs of the wearer exceed the mandatory measurement of 2m.

You have therefore been charged with 2 counts against common decency:-
(1) I understand that you are aged 63.And a very old and frankly,decrepit 63.
(2)Additionally, that your thighs have a combined circumference of 7 m.

DCI Knacker from the specialist 'Lingerie Squad' has asked me to inform you that if you wear a black mini-skirt and black pantyhose,that you should not wear white underwear-even if you think that white knickers are invisible underneath your black hose...because they aren't invisible and a small child has had to be referred to the PTSD team for immediate intervention after you sat in the waiting room, apparently endlessly crossing-,and uncrossing-,your legs.

Please pay this fine directly by donating your mini-skirt to Oxfam so that they might turn it into a tent for the crisis in Darfur.

Supt Percy Vereance

Buy One Get One Free

Dear Miss Informed

On behalf of the management I would like to unreservedly apologise for the fact that you had to wait 40 minutes yesterday to see me.In fairness though,you were seen by the Triage Nurse within 5 minutes of your arrival .

Of course,the fact that you (and the rest of the local population who do not earn enough money to pay for cable television) ,braved the snow to all attend at the same time-Sunday afternoon,just after the shops closed-,may have had something to do with the length of the waiting time.

And I do appreciate that you felt uncomfortable sitting in the waiting room because the other patients were staring at you...mainly because even they could not stand the smell coming off of your unwashed body and clothes.

And I am sorry that I only spent 15 minutes examining you...in fairness though,I didn't put on the BioHazard face mask until you took your jeans off to allow me to examine your knee.
Boudaecia,the Health Care Support Worker (who was acting as a chaperone for me-because frankly you looked both 'stupid' and like a trouble-maker),sends her own apologies for gagging at the smell when I lifted up your leg so as to enable me to take your knee through all of the necessary range-of-movement tests.

Nevertheless I am confident that you were adequately examined...particularly as there did not appear to be anything wrong with you that a visit to the public baths;followed closely by a referral to the denture clinic;and,finally, that a tube of pimple cream, would not cure.

I appreciate that your knee was painful and that you were limping but this problem will be immediately rectified by getting your shoe heel fixed .Oh...and by taking some paracetamol.

However ,I can only apologise for leaving you so abruptly as I was discussing your diagnosis with you .This was prompted by the receptionist running into the Unit shouting for help because a young mother had brought in her baby who had stopped breathing whilst she was on the bus.

Unfortunately,as the only ALS-, and PLS-trained Nurse on duty I was bureaucratically tasked to attend the resuscitation.This is,after all,why large sums of money have been spent on my education.Of course,there was also a moral and ethical obligation coupled with a normal human desire to try and save the life of an 8-month old baby.

I admit that I was in the Resus Room for the better part of 45-minutes as we stabilised the baby and waited for the Paediatric Retrieval Ambulance to come and take the child to the main hospital. Fortunately then still alive.

I do feel sure though that Boudaecia told you that I would return as quickly as I could to complete your examination. I quite literally trust her with my life and so,-when I asked her to tell you that I was unavoidably detained-,and she told me subsequently that she had,I believe that she did.

So despite this apology,I am at a loss as to why you then re-booked into the Unit,and was then completely re-examined by a colleague without telling her that you had already been examined and that you were waiting for me to finish resuscitating a dying child -particularly as she could also find absolutely nothing wrong with you ?

Perhaps you could let me know at your convenience ? And after you've changed your underwear ?

Kind regards
Lucien de Beer

Not since 1872...

...has England lost so badly...suck it up!

LONDON: World champions South Africa dealt a hapless England their worst defeat at Twickenham with a crushing 42-6 victory in a lopsided rematch of last year's World Cup final. The Springboks, who had already beaten Wales and Scotland, made pre-match suggestions that they were too tired look laughable with a performance of classy opportunism in attack and dogged determination in defence. Tries by Danie Rossouw, Ruan Pienaar, Adie Jacobs, Jaque Fourie and Bryan Habana and assured goalkicking by Pienaar after the break completed a hugely satisfying European tour with South Africa's sixth win in a row against England.

Hippy-Hippy hand injury

" Mr Anchor ? Mr W Anchor ?"

A young man , dressed in the 2008-concept of what a 1960's hippy used to look like, waves languidly at me whilst playing,-one handed-, on his PSP. Various electronic noises suggest that he is finishing an important level of his retro 'Donkey Kong' game.
He remains fixated on the screen.
Already,- and quite irrationally-, I dislike him.
He has more facial piercings than a Pygmy in a 1930's Tarzan film.

" In your own time there Sir...theres no rush...everybody else here is just waiting for the bus...or sheltering from the rain...and fortunately for me , I'm paid by the hour."

He saunters into the Unit and shows me a swollen and bruised right hand with an obvious boxers' fracture to his fifth meta-carpal.
Its his dominant hand.
He tells me how he was walking back from Bible study and slipped on the ice and 'just landed awkwardly'...somehow injuring his hand.

I manage to fit in the Top Gun "B*llshit" cough whilst filling in the x-ray request form.

"Have you taken anything for the pain ? Would you like anything ? "

No...I don't like putting chemicals into my body...

"Fair enough...Okay...but you do smoke ?"

Yes...but only roll-ups

"And do you drink at all Sir ?"

Well...only at the weekend...only cider really...and sometimes Red Bull and vodka...

"Okaaaaaay...but you don't want to take some paracetamol and neurofen for what is an obviously broken hand ?"

No...never...those tablets are made by capitalist-pig, running -dog multinational drug companies...who are evil , denying ART drugs to the developing world...and every drug is tested on animals and on prisoners in Guantanamo Bay...

Here comes another "B*llshit" cough.

Yes they are...here...have a look at this pamphlet from Idiots Against Any Form Of Drug Research

*sigh*

After the x-ray is taken and I have discussed the films with the Hand Surgeon on call,who wants to operate today such is the angulation of the meta-carpal , I go and give my ersatz-hippy the good news...

"Okay Sir...here's the x-ray of your hand...quite a nasty break there in fact...the hand surgeons are keen to operate tonight"

Tonight ?

"Yes...tonight"

Well...I've got plans for tonight!!!

"Well ...Sir...its really your choice...I can only offer you an educated opinion...basically its mind- over-matter"

Mind over matter...are you saying I can heal myself then ?

"Ahh...no...thats as , 'I don't mind'....and then you try and complete the sentence to make a well known phrase"

Oh...Okay then ...will I need to be put to sleep?

(I wish!)

"Well...we will give you a anaesthetic of some sort...perhaps what we call a Regional Block...but since you don't like taking drugs...well...as I say...that's your decision and its still just mind-over-matter...for me"

Oh...Okay...can I phone my Mum?

Uncle Jimmy - R.I.P.

We cremated my Uncle Jimmy today.
He was a nice man-a bit of a rogue given half a chance , but one who knew where his duty lay...his duty to his country , his family and those who loved him.

Crossing the Bar

Sunset and evening star,
And one clear call for me!
And may there be no moaning of the bar,
When I put out to sea

But such a tide as moving seems asleep,
Too full for sound and foam,
When that which drew from out the boundless deep
Turns again home.

Twilight and evening bell,
And after that the dark!
And may there be no sadness or farewell,
When I embark;

For tho' from out our bourne of Time and Place
The flood may bear me far,
I hope to see my Pilot face to face
When I have crost the bar.

Alfred , Lord Tennyson

Alien surgery ?

Multiply-Married-Michaela (aka '3M') slopes into my exam room...

'Can you check a patient for me ? I have a weird x-ray '

She gets most of her patients triple-consulted...and only comes to me as a last resort...I'm the only person she works with who is honest enough to tell her to give up her day job and get a job as a check-out clerk at a supermarket...

"Whats the story?"

'Well...my patient says that he woke up this morning with a painful left leg...he had a few drinks last night and may have fallen and injured his leg...anyway...he can't weight-bear on that leg...and he's crying in pain'

"Jah...and?"

'Well I x-rayed his leg and I can't see a break but there is some odd thing in his tibia...and I don't know what it is...'

"Okay...well...he's had an old fracture...look there on the tib and there on his fib...and the 'weird thing' that you can see is an orthopaedic metal pin...but there's nothing obviously new on this film...oy...lets go and have a look at him them"

We walk into 3M's exam room where a large sweaty man bearing a close resemblance to the love child of Jabba-the-Hutt and Princess Fiona from Shrek is lying groaning on the trolley.

He is wearing shorts and a dirty t-shirt...and its 3C outside and raining.
His left leg is mildly swollen in comparison to his right leg...more importanly,it shows several old surgical scars

"Good day Sir...my name is Lucien...when did you break your left leg then?"

I've never broken my leg!!

"Really...well come and have a look at your x-ray..."

I can't walk...

'He can't walk!!'

"Yes you can...come on...get up and have a look at the film..."

And of course he can walk...he jumps up off of the trolley and jogs into the viewing room...
and looks at the x-ray...
and denies having ever broken his leg...
or ever having had orthopaedic surgery...
despite me showing him the scars on his leg...
and suggests that maybe he was born with a piece of surgical steel in his leg...
that perhaps...
-and its a long shot,he appreciates-
but perhaps , he is half man/half cyborg...

"Well Sir...I guess that you've sprained your ankle...you need to go home and rest it for a while...by the way...how long have you been taking the schizophrenic meds?"

Oh...about 20 years...

"Okay...well...3M will organise a taxi back home for you"

Thanks...but could you just send me back to St Nutters Misercordia psychiatric hospital?

"No worries...Okay 3M? ...will you organise that then?"

ENP's 1 - Psych service NIL

Wonky Willy Wishy Washy

The myths that got Baby Boy "P" murdered

Another child has successfully been murdered by his "mother" , her 'partner' and , -unbelievably- , their lodger.

Sky news reported the story today as follows:-

The 17-month-old boy - known only as Baby P - suffered injuries similar to the "force of a car crash".
Just two days before the boy was found dead in his blood-spattered cot, a doctor failed to spot his broken spine.
And police told the mother she would not be prosecuted after being arrested twice for suspected child cruelty.
The toddler was found dead in his home in north London on August 3 last year.
Baby P had more than 50 injuries or bruises and an attempt had been made to cover up the crime. By the end, he was unrecognisable, his curly, golden locks shaved off.
He had a broken back, nine fractured ribs, fingernails and a toenail missing, a severe mouth injury, a ripped ear and extensive bruising on his body.
He also had sores and puncture wounds on his head.


Here's the deal Mr Brown:-

1. It is not possible to rehabilitate parents who physically or sexually abuse their children despite what the social workers say.Period.



2. It might be possible to rehabilitate parents who neglect their children but no one at the sharp end really believes that either.'Neglect' is the precursor to violence.



3. The parents may or may not have been abused themselves as a child-frankly I do not care-its their child that is the victim here , not them-so lets start to focus on the rights of the child.



4. Its not that there is no one to blame;rather,its that despite the Laming report there is no provision for a designated person to manage an individual allegation of abuse from beginning to end.



5. When I was working at the Johannesburg Hospital children's casualty,the person who identified the abuse was legally required to immediately contact detectives from the Child Protection Unit;the hospital Social Workers (and the hospital Lawyers if needed) to hold a mandatory and immediate case conference.The reporting/diagnosing person was expected to drive the case.



6. The radiological consequences of performing a skeletal survey on a baby deemed to be at risk are nothing compared to death-tell the radiographers to suck it up and do as they are asked by those of us who have long experience in children's emergency medicine.



7. Try to convince the police that its really time they stopped filling in forms and started getting out into the community and working with nurses and doctors who phone then.



8. Lets stop pretending that Management gives any real support to staff who identify and attempt to resolve child abuse issues.By and large they are simply not interested.



9. Lets also stop pretending that all health professionals/police officers/social workers want to get involved-most just can't be bothered...its nothing to do with the 'horror',its to do with having to call colleagues to account;to being prepared to make accusations;to being maligned by so-called human Rights lawyers at the Court.



10. It's time to establish a national register of people who will be prepared to get involved.This happens informally in practice where I work where I have identified a handful of medical and nursing colleagues who will step up to the issue and take ownership of an abused child.



11. Finally lets stop making excuses. Alcoholism and drug use and being unemployed and living in Council accommodation are not excuses for killing your child...even if your lawyer wants to use them as "mitigating" reasons in your defense...defense...what a joke!!

Herewith endeth the lesson.

Letter to your doctor

Dear Doctor


I have today examined this patient and during the course of the consultation I have found that they fit the requirements for an urgent optorectomy.

This is a new procedure that we are offering , in which we sever the nerve that runs from their eyeballs to their rectum , thus curing them of their crappy outlook on life.

Please schedule them at the earliest possible opportunity as this patient is a truly miserable bastard .


Kind regards

Lucien de Beer

Ah...young love...what a glorious thing...oops,

The harsh discordant 'come to the Resus Room NOW' alarm bell cuts through my relaxed conversation with a new mum and her first-time-ill, beautiful bouncing four-month old baby.

"Excuse me...that's the emergency alarm...", I shout over my shoulder as I dash from the room,grabbing my stethoscope on the run...

And then I realise that my very expensive PDA is on the desk.

Mid step , I execute a perfect pirouette and dash back to get it.

Its not that I don't trust the young mum,but after all , she is a struggling single parent and it wouldn't be the first PDA I've had stolen by a patient.

"Sorry".

Snatch up the PDA and run back to the Resus Room only to realise,-half way there-, that my Mont Blanc fountain pen is also on the desk...and then run back to get that as well.

Honestly...I know that you are busy dying...but it took 42 hours of overtime to get the money for that pen.

Finally running into the Resus Room , I see a young woman ,soaked in sweat , desperately struggling to breathe...using her entire body to try and get some air into her lungs...even her earlobes are flaring...

"Are you asthmatic?? Just nod your head !!"

Frantically,staring at me,she tries to nod her head.

Quickly I listen to her chest-the total lack of any real air entry except for a little squeak...we start a nebulizer and get an IV line started and give her some meds.

Gradually she starts to calm down,her breathing eases and I can get a full medical history from her.

In the meantime, Julian my trusty Health Care Support Worker,has been getting a brief history from a shocked-looking young man who has introduced himself as her boyfriend,and who has sat transfixed in the corner of the room during the initial moments of the consultation.

He says that they were driving back from the mandatory Saturday afternoon shopping expedition when his girlfriend said that she couldn't breathe and so he drove to the Unit.

He doesn't know much about her health as he has only been dating her for 4 months and had only just,that weekend,moved into her flat.

Finally she can talk.

"Can I just check that you are asthmatic?"

Yes

"Have you had an attack like this before ?"

'No' , says the boyfriend ...

Yes...I've had six admissions to St Vulva's in the last nine months...once to ICU...

'Really?'

"Okay...just relax...carry on using the neb...I just need to get a bit more history from you while we wait for the ambulance...so...do you have any other medical problems?"

She lists two more life-long medical conditions...and lists the five different meds she takes each day...to the obvious discomfort of her boyfriend.

"Do you take the Pill...I think that you'll need some antibiotics at the hospital?"

No,I don't use any contraception

'You told me you had the injection !' says Boyfriend.

"Are you allergic to anything ?"

She is...

"What work do you do?"

I work at St Vulva's hospital...in the operating theatre...

"Oh ja...what do you do?"

I'm a cleaner in the Central Sterilizing Department

'A cleaner ? You told me you were a nurse!'

The boyfriend now looks like he has bought the losing ticket in the lottery of life.

Fortunately the ambulance arrives to take her up to the main hospital.Julian gets all the pieces of paper together and chivves the paramedics to get going.

"Are you going to go up to the hospital in the ambulance with your girlfriend...or drive up behind the ambo?"

'Nah mate...I'm going to go back to the flat and pack up my gear...all that stuff wrong with her...well...look at her...I mean...its not like shes' Angelina Jolie is she...and all those medicines and allergies and stuff...and she's a cleaner ! ...no mate...I'm not wasting any more time with her am I...I don't want to take care of some cripple when I get old do I ?'

*sigh*

...thus stressing his girlfriend and setting off a new round of bronchospasm ...


True lust...it never lets you down.

Trust me...I'm a "doctor"...I can cure anything

Another plastics referral...

"Hello...is that the Plastics Registrar on call ?"

Yes

"Hi...its Lucien at the Minor Injuries Unit...I have a chap with burns to his face and I would like to refer him to you please"

What sort of burns?

"Well...he has partial thickness burns to both lips and nostrils...and some blistering to his cheeks and forehead...umhh...his airway isn't compromised...and his eyes are okay...the burns happened sometime in the night..."

What caused the burns?

"Well...the patient reports that he was with some people...who may,or may not,have been friends...he was smoking a home-made roll-up cigarette...that he had got from someone at the party he was at...he doesn't know who it was...and that it apparently exploded in his face...umhh...but then he fell asleep and when he woke up this morning his face was burnt."

Was he drunk?

"Well...he doesn't know if he was drunk...but he thinks that he may have been drugged...I asked him at what point he thinks he may have been drugged and he says he thinks it was after he had finished the two bottles of vodka and 13 cans of XXXX lager...but he's not sure..."

Okay...are you really really sure that his airway isn't compromised? And that he can see okay ?

"Ja...he's breathing just fine...and his VA is perfect...and this happened about 15 hours ago...he has just got out of bed..."

Okay...pop on the usual dressings and send him over.
Thanks for the referral.
I think.

"Ja...thanks for taking him..."

Nurses-1, G.o.m.e.r.'s-ZERO

Smoking may be hazardous but laughter is just fine...

The warm , comforting embrace of Islam...NOT

Somalia: Girl stoned was a child of 13 : Posted on AIUK on November 1

Girl sentenced to death for being raped

Contrary to earlier news reports, the girl stoned to death in Somalia this week was 13, not 23, Amnesty International can reveal.
Aisha Ibrahim Duhulow was killed on Monday 27 October by a group of 50 men who stoned her to death in a stadium in the southern port of Kismayu, in front of around 1,000 spectators.

She was accused of adultery in breach of Islamic law but, her father and other sources told Amnesty International that she had in fact been raped by three men.
They then attempted to report this rape to the al-Shabab militia who control Kismayo, and it was this act that resulted in her being accused of adultery and detained.

None of the men she accused of rape was arrested.

David Copeman, Amnesty's International Somalia Campaigner, said:
'This was not justice, nor was it an execution. This child suffered an horrendous death at the behest of the armed opposition groups who currently control Kismayo.
'This killing is yet another human rights abuse committed by the combatants to the conflict in Somalia, and again demonstrates the importance of international action to investigate and document such abuses, through an International Commission of Inquiry.'

Amnesty International has learnt that: Her father said she had only travelled to Kismayo from Hagardeer refugee camp in north eastern Kenya three months earlier. She was detained by militia of the Kismayo authorities, a coalition of Al-shabab and clan militias. During this time, she was reportedly extremely distressed, with some individuals stating she had become mentally unstable.

A truckload of stones was brought into the stadium to be used in the stoning. · At one point during the stoning, Amnesty International has been told by numerous eyewitnesses that nurses were instructed to check whether Aisha Ibrahim Duhulow was still alive when buried in the ground.

They removed her from the ground, declared that she was (alive), and she was replaced in the hole where she had been buried for the stoning to continue.

An individual calling himself Sheik Hayakalah, was quoted on Radio Shabelle saying: 'The evidence came from her side and she officially confirmed her guilt, while she told us that she is happy with the punishment under Islamic law.'

In contradiction to this claim, a number of eyewitnesses have told Amnesty International she struggled with her captors and had to be forcibly carried into the stadium.

Inside the stadium, militia members opened fire when some of the witnesses to the killing attempted to save her life, and shot dead a boy who was a bystander. An al-Shabab spokeperson was later reported to have apologized for the death of the child, and said the milita member would be punished.
Background · Amnesty International has campaigned to end the use of the punishment of stoning, calling it gruesome and horrific. This killing of Aisha Ibrahim Duhulow demonstrates the cruelty and the inherent discrimination against women of this punishment.

The reports on this killing should be understood within the climate of fear that armed insurgent groups such as al-Shabab have created within the areas they control in Somalia.

As Amnesty International has documented previously, government officials, journalists and human rights defenders face death threats and killing if they are perceived to have spoken against al-Shabab, who have waged a campaign of intimidation against the Somali people through such killings.

Since the death, a number of individuals have told Amnesty International they have fled from Kismayo out of fear of suffering a similar fate to Aisha Ibrahim Duhulow.