New diagnosis - F2S2 event

"Mr Trousers ? Mr Peregrine Trousers ?"

A middle-aged man stands up and collects an overcoat, scarf, hat ,gloves and briefcase from the chair next to him. He is expensively-if a little flamboyantly-, dressed.He has a good haircut and couldn't be more out of place than if he were George Bush at a Mensa meeting.

"Good evening Sir...what can I do for you today then ?"

Well ... he lisps ...its my finger...its very painful and I don't know why

He then,-quite literally-,gives me the finger,raising the middle finger of his right hand and pointing to the middle phalanx , saying that he has had pain to that part of the finger since he did his weekly 10-mile cycle on Sunday.

He is adamant that he didn't injury it , saying that he just noticed after the ride that the finger was painful... and just the middle part of his middle finger.

Taking a brief social history , I discover he is a confirmed bachelor;likes the music of Cher,Barbra Streisand and Bette Midler;and that in addition to his cycling , he also does Jazzercise to stay fit.

He works 'in the media' at a job that is "very complicated -you wouldn't understand dear boy"...he tells me disdainfully...

"Dear boy" !!!!!"

Good grief !!!!

He is right-hand-dominant, there is no history of trauma;he doesn't have a temperature;and his finger is not warm or red or even swollen.He has a full-range-of-movement in the finger with no neuro-vascular deficit and no bony pain to any part of his finger and hand.

In short , there is nothing wrong with it.

"Right ...well Sir...I don't think that there is anything too sinister going on with your finger..."

Really ? he sniffs , looking unconvinced.

"Yes...I think that you are experiencing what we call an F2S2 event..."

Oh...what does that mean ? I've never heard of it ?

"Well...its quite uncommon...rare even...but a simple condition...nothing to worry about and easily cured...do you know anything about feng shui ? "

Well yes...in fact my whole flat has been cleared and balanced and harmonised and arranged by a Master Practitioner'

"Good...well the same principle applies here...essentially the energy in your hand has been disturbed...probably...and in truth we will never know why...but probably because you inadvertently damaged the finger sometime in the last 2 weeks..."

Yes ?

"And so the balance of all the 27 bones in your hand has been disturbed...so we need to just briefly re-balance them...are you willing to try ?"

What do I need to do ?

"Well...just hold your hand out in front of you as if you are holding a cup...now...put your little finger out to the side...like you see people doing when they drink tea in an old movie..."

He duly mimics holding an imaginary cup of tea and sticks his little finger up in the air...

"There...now ...does the pain feel better ?"

Yes...in fact its completely gone...that's amazing...

"Okay...well...do that about 3 times a day for about 15 seconds a time for the next week and the pain should resolve..."

By the way...what does 'F2S2' stand for ?

"Feng Shui Finger Syndrome "

I'm sorry...can you say that again?

The top five rhetorical questions asked by staff to patients in our Unit so far this year are:-

1. So... have you taken any medicines for the pain ?

2. So...have you given your child any medicine for the temperature ?

3. So...did you try and cool the burn down ?

4. So...do all your children have different father's then ?

5. So...are your child's vaccinations and inoculations up to date ?


With this question edging very closely into sixth place :-

6. So...do you really think that I don't know you're lying ?

Pedestrian vs. Car

I almost knocked over a pedestrian last night.

It was raining and was pitch black,and the pedestrian ,who was a Goth teenager...dressed all in black...was busy fiddling with his cell phone as he walked along the pavement,with the headphones clearly lodged in his ears.

He simply changed direction , and turned left off of the pavement and onto the pedestrian crossing without looking at anything other than the screen of his cell phone.

Fortunately the combination of probably 2000 ripe-pustular-pimples set against a wide pale-moon face,made him fleetingly visible...just call me Vinnige Fanie!

And yet...had I knocked him over he would have claimed that it was my fault as he ,-legally-had right-of-way on the crossing.And doubtless the fuzz would have been all over me , like plaque on a coronary artery.

Now I should point out for the benefit of non-UK readers that most pedestrian crossings here are simply a series of painted white stripes on the road,with a "Belisha beacon" -(which is a flashing orange globe set atop a tall black and white pole)- , next to it, just like in the picture at the top of the post.

Their function is to provide additional visibility to zebra crossings for motorists, primarily at night. The flash commonly lasts one second in both on and off states.

They are named after Leslie Hore-Belisha, a Minister of Transport , who introduced them in 1934.

Hummh...wonder why they didn't call them a "Hore" Beacon...a term that in today's' Binge-drinking Britain, would be far more appropriate !

Pedestrians still comprise around a quarter of those who die in road collisions and statistics
published by the Department for Transport (2004) show that in Great Britain in 2003 over 290,000 people were killed or injured in road traffic collisions (36,405 were pedestrians).

Of course,these stats are no surprise to anyone who has driven in the UK for longer than a day, because in addition to the teenagers plugged into their phones and MP3's there are also a whole host of other assorted thickos who put themselves at risk including :

1. Cyclists who suddenly decide that its easier to get across the road by suddenly stopping and turning onto the pedestrian crossing , rather than waiting for a break in the traffic flow-also without looking.BTW...very few cyclists wear helmets or any sort of reflective jacket as they are paradoxically harder to steal than a bicycle.
2. Joggers...who anyway think that they have some divine protection because they are ...like...running...while you are ...like...not running
3. Old Age pensioners who stand looking both ways for 5 minutes...then wave you on past them...and then step into the road
4. OAP's on mobility scooters who also think that they have automatic right of way
5. Students playing 'chicken'
6. The drunks...always belligerent...who stand in the middle of the crossing shouting insults at all and sundry
7. Assorted foreigners and tourists who have no idea where they are, from which direction the traffic is coming and or indeed,how they are supposed to get across the road when there are only 2 flashing yellow lights to protect you ?

So...as I say...I almost knocked the pedestrian over last night...

And it wasn't for lack of trying either...

I even reversed...and then followed him down an alley but he managed to get onto the top of a metal dustbin...and think of the damage that a dustbin could do to my car !

http://www.pedestrians-int.org/content/18/222006_p.pdf

The single biggest killer of men is....

Sunday morning and as I click on the 'Next Patient' button on my computer,I see that the case has been flagged up for my attention.

This usually means that the patient has complex medical needs or is very ill or is barking mad or is a man with a urological problem.
Just occasionally,its an attractive young woman with a sore throat...put through to me by the Triage Nurse , just to cheer me up and keep me motivated.

A gelled-hair, acne-ridden, truculent looking teenager comes into my room.He is inevitably ,wearing a dirty England football shirt with 'Beckham' on the back,and those low-slung trousers that just look stupid.

He swaggers into the room ,chewing gum with that vacant yet challenging stare,and sprawls,-uninvited-,on the patent's chair.He's still plugged into his iPod.

"Please...make your self at home...why don't you ..."

Wot?

"Please switch off the iPod and remove the headphones...or go back outside."

With a great sigh and theatrical indifference he complies with my request.

"Right young man...what can I do for you today then?"

Its my cock,innit !?!

"I beg your pardon ? Do you have a problem with your penis then?"

(Oh happy day...just what I need before lunch!)

Well...yerhh ?

"Okay...so whats been going on ? What's happened?"

Well on Saturday I had sex...and I think I have a problem now

"So...what type of sex were you engaged in ? In the episodic-solitary-single handed-sexual-activity kind of sex...was it ?

Wot?

"Were you masturbating ?"

Wot ?

"Spanking the monkey ? Choking the chicken ? Milking the cobra ? Bleeding the dragoon ? Restoring the balance to the universe ? Twisting the sheriff and waiting for the posse to come ? Performing diagnostics on the king ? Burping Kojak ? Five-knuckle-shuffle on the elephant's trunk ? Yankin' the self-serve pump ? Scratchin' the purple people pleaser ? Making like Hans Solo and stroking Agent Johnson ......you know......wanking ?

Oh...yerhhh

"And whats going on then ? Whats the problem ?"

Well...it won't go back to normal

"What 'won't go back to normal' ? Are you having a problem with your foreskin ? Can't you pull it back then ?...Okay...well...lets have a look"

I snap on the gloves and switch on the light.

You're not gonna touch it are you?

*sigh*

"No...I promise you that I will try to restrain myself from touching your penis...as difficult as that may be"

He drops his pants and pulls out his much-thumbed member.

I actually rocked back on my chair...he had the biggest ,shiniest , purplest paraphimosis I have ever seen.

It looked like a python was swallowing a small dog.Sideways.

It looked as if he had wrapped a life-belt around it.

One with a flashing red light on it.

It was so big that it had its own liver.

"Okaaaaaaaaay then...so this happened on Saturday then ?"

Yes...Saturday last week

"Right...8 days then...have you been able to pass urine ? Pass water ?"

No...not since Friday night

Will you be able to help me ?

I'm really scared!

The On-call Urologist had him in theatre in under an hour.


And so,Dear Reader,its not testicular cancer or prostate cancer that kills men.

Its embarrassment.


http://emedicine.medscape.com/article/442883-overview

http://www.urologychannel.com/emergencies/paraphimosis.shtml

Who's your daddy ?

These are apparently "genuine" replies to a 'Child Protection Agency' questionnaire .They are all...anyway...very funny

Regarding the identity of the father of my twins, Makeeshia was fathered by Maclearndon McKinley I am unsure as to the identity of the father of Marlinda, but I believe that she was conceived on the same night

I am unsure, as to the identity of the father of my child as I was being sick out of a window when taken unexpectedly from behind. I can provide you with a list of names of men that I think were at the party if this helps.

I do not know the name of the father of my little girl. She was conceived at a party at 360 East Bolton Avenue where I had sex with a man I met that night. I do remember that the sex was so good that I fainted. If you do manage to track down the father, can you please send me his phone number? Thanks.

I don't know the identity of the father of my daughter... He drives a BMW that now has a hole made by my stiletto in one of the door panels. Perhaps you can contact BMW service stations in this area and see if he's had it replaced...

I have never had sex with a man. I am still a Virginian. I am awaiting a letter from the Pope confirming that my son's conception was ejaculate and that he is the Saver risen again.

I cannot tell you the name of Alleshia's dad as he informs me that to do so would blow his cover and that would have cataclysmic implications for the economy. I am torn between doing right by you and right by the country. Please advise.

Tyrone Hairston is the father of Child A, if you do catch up with him, can you ask him what he did with my AC/DC CDs? Child B, who was also borned at the same time.... well, I don't have a clue.


My favourite response...given to me by a mother last weekend when I asked her who the father of her baby was...to get a complete medical history on a very sick child...in my Resus Room ...was..."I don't know who the father is,'cos he left before she was born..."

I guess that she was following the advice in the "Miss Manners Guide for Sluts" , pg 69...where it suggests that you do not want to seem impolite by asking your arbitary sexual-partner his name -before,during or even immediately following the sex-,unless you have a good reason to do so...like putting it on your daughters Birth Certificate...

P.C.Plod and the mysterious case of the disappearing PDA

I love my PDA.

Love it!!

I take it to bed with me and fondle it,with crazed , sweaty half-remembered dreams of flicking through Diagnosaurus desperately deciding a differential diagnosis

I have had PDA's ,starting with the Psion...ah...what a nerd I am,-of increasing complexity and power,loaded with ever more and more aide memoire medical software-since 1993.

I cannot function without it in my pocket.It is my muse,my security blanket,my last-protection-against-the-dyslexia,the lifeline of my patients when its 2230 and I am tired after a 14 hour shift.

And it was stolen from my desk by a patient on Saturday night.

It was there at the start of the consultation...I left the room to get the patient some analgesia because I needed to send them to St Vulva's for a MaxFax consultation...walked the patient out to the waiting room...and when I returned to my room,saw that the PDA was gone...rushed back out to the waiting room , but the patient had already left the Unit.

At least the patient didn't benefit from a having surgery for the Le Fort fracture!!

I know...I know...I am too trusting

I can't help it.

I choose to live a life where the glass is always 'half-full'...where I assume that other people are basically nice...good...will behave ethically...I think..."well the patients,-who are all complete strangers to me-,are trusting me not to kill them...and perhaps ...perhaps even to cure them...and so I have a sense of 'reciprocal trust'"

I believe that I really should care for my patients and look out for the stupid and uneducated,even if the candle of empathy is flickering in the cold wind of complete indifference.

I believe that individuals can make a difference...that ideas move nations...that we all count ...

I have had the privilege of sitting with President Mandela at 6a.m.,drinking tea and discussing life...he called me 'a true South African'

I know its stupid but I simply refuse to live that bitter and cynical life that so many people choose to live... that life of quiet desperation.

And of course...this patient was known to me...I have their name and address...and despite all the warm fuzzy remarks above,I am still 1,8m and 135kgs of p*ssed-off South African...who knows where you live you halfwit!!!

And trust me,revenge is a dish best eaten cold...very cold.

But of course,because the theft happened at work I had to call the police.

I should probably say at the outset that I have little time for police officers-for a whole variety of reasons related mainly to my experiences in South Africa...where the police enforced immoral laws such as the so-called Section 10 Pass Laws,where 'Black' South Africans were forced to carry a "Pass", (a form of internal passport) and could be arrested if they didn't have it on them when stopped.

I was 16 when I was interrogated by the Security Police for the first time.

My 'crime' was that I had organised a donation of books to start a library in a 'Black' school in a 'Black' township...and as a 'White' teenager,I had no 'legal' right to be there.

Now let me tell you...in 1973, when those guys read you your rights it went something like this...

"You have the right to scream...You have the right to scream as loud as you want...No one cares...You have the right to vomit...and if you vomit on me,you will scream"

Over the years that followed,as my involvement in 'anti-apartheid' activities increased,the aggravation frankly just got to be part of my life...the unnecessary traffic stops for example...and the 2a.m. phone calls which usually went something like "Hey you fat bast*rd...we'll shoot you tomorrow"

Well...shoot me...or don't shoot me...but is it really necessary to wake me at 2a.m. just to call me fat ?

Now that's a cruel and inhumane punishment.

Of course in the end despite 2 documented attempts on my life they didn't manage to kill me although on one memorable Friday morning in Thokoza,in 1993,they did kill my friend Jeff Sibiya,who was waiting patiently for me to come and deliver some food parcels.

I was delayed.

He died.

Aluta continua.

And after the end of apartheid things didn't really improve...as one of the Security Policeman said..." once a human-rights activist,always a trouble maker-don't think that your file has been shredded"

Of course,it did get easier to bribe the cops.

I had hoped that the UK would be different,but its not.

The police here ponce around in their circumcised ,priapic hats,speaking slowly in that mangled ,ostensibly English vocabulary,seldom seen and ineffective at anything other that wrestling with drunks-'rugby training' as we call it in Jo'burg-and ensuring that they are -at all times-politically sensitive and correct.

My arse!!

Two years ago I was assaulted by 3 teenagers...the height of summer,one Sunday afternoon,walking along the local boardwalk,enjoying the time off in the sun....no one came to help despite there being a Lifeguard station about 20metres away...naturally I fought back and cornered the teenagers in a shelter and phoned '999' for help...of course , they never came...eventually the kids ran away...and having waited another 10 minutes,I cancelled the call.

The next day I was contacted and told to immediately attend the local cop-shop to file a statement about cancelling the '999' call.

How dare I waste police time ,I was asked?

I seem to recall that my long and articulate and complicated post-ironic reply,citing case law,Shakespeare and even Euripides went something like this..."F**k 0ff"

This resulted in an endless correspondence with the Chief Constable including at one stage being invited to join the Police Authority!!

And so,with very little hope that the police would actually do anything,I phoned their "customer contact centre"

It was a surreal conversation which ended by the call-taker saying that since it was "only" my word against that of the patient,that the police would not be investigating the theft.

Just like that then.

The bizarre conversation included the following two questions:-

So I'm sorry to ask you this...but what is your date of birth?

"Lady...ask me anything you want...you can ask me the size of my willy if it will help get my PDA back!!"

Well!!...there's no need to be crude Sir!!

and

Finally...would you like me to send someone from Victim Support to help you through this crisis?

"Well...firstly...its not a crisis...the situation in Darfur is a crisis...this is a theft...and so...what I want...what I really really want...is for you to arrest this miscreant and then run so much electricity through their privates that they confess to the assassination of Kennedy !"

Well...we probably don't torture people here Sir...
By the way...who is this Mr Kennedy that you're talking about?
Was he involved in the theft ?

Funny Looking Parents

A mum-to-be is preparing to give birth to conjoined twins with two heads but one body

Lisa Chamberlain, 25, had a scan last week which showed her embryos had two heads and one body - making them dicephalus twins.

The Catholic mother-to-be said doctors advised her to undergo an abortion but this was ruled out after talking over the matter with fiance Mike Pedace. They have been told the twins have only a 20% chance of survival.

"They're conjoined at the upper part of the body so they share one body and they've got two heads," she said.
"Doctors told me that I may never be able to conceive because of my polycystic ovary syndrome and I had practically given up.

"I thought, it's not going to happen now, so I've just got to accept it.

"They'd advised that I should have a termination mainly because it would save me heartache further down the line, but I've told them there's no way I'm going to have a termination and I want to go ahead with my pregnancy.

"I believe everything happens for a reason and there was a reason why God chose me to be their mum and there's absolutely no way I would consider an abortion.

"I'm very happy and proud of my twins and they deserve every chance in life."

A spokeswoman for Great Ormond Street Hospital in London said , "The prospects for conjoined twins vary widely according to how well the children are and in particular how they are joined, and what organs are joined or shared.

"In general children joined at the heart are inoperable and sadly will usually die. GOSH has also seen inoperable cases joined at the brain who would also have died, although we have successfully separated two children joined at the brain and the children are doing well.

"Success rates will vary depending on case by case circumstances."

If the babies survive after birth, they will become the first ever British living dicephalus twins.
The condition occurs in just 4% of Siamese twin births.

Michaela Aston, from the charity LIFE which offers counselling and advice about abortion to parents, said: "This young mother is an example to us all as she unconditionally welcomes her twins into the world.

"She knows it will be difficult but she is focusing on the fact that she is already the proud mother of these babies and accepts them however they are. They may not be perfect in the eyes of the world but they are fully human and as such should have the same value and right to life as any other human beings.

Lordy Lordy...Ms Aston is clearly a "glass-half-full" sort of person....

"It is sad that this young mother must face a society which is increasingly unable to accept babies who are not genetically perfect and which may judge her for allowing her twins to continue to live.

"If they do survive, their future will not necessarily be bleak as is demonstrated in the very full and happy lives of teenage twins in the USA who have the same condition, Abigail and Brittany Hensel."

They were born in March 1990 with shared organs below the navel and are still alive.

http://uk.youtube.com/watch?v=BkKWApOAG2g

But conjoined twins expert Professor Lewis Spitz said that Mrs Chamberlain's embryos should be terminated. They would have a greater risk of infection, he said, and have two heads controlling one side of the body's nervous impulses.

Professor Raanan Gillon, the Emeritus professor of Medical Ethics at Imperial College, said it was a very personal decision.
"I just want her to be clear about what she believes she is doing in moral terms," he said.
"If she believes that abortion is morally equivalent to murder, which I don't agree with, I wouldn't want to try to change her mind.

"But if she doesn't think that, I would be keen for her to think about the implications of bringing into the world two people joined together, and whether she actually wants to participate in that."

In a nine-week scan carried out on Miss Chamberlain's twins, doctors could only identify a single heartbeat, although they say a second heartbeat could emerge by the time of a 12-week scan. It will only be at the 20-week mark that doctors will know to what extent the twins are conjoined.

The twins were diagnosed after Miss Chamberlain, a former RSPCA worker, was taken into Portsmouth's St Mary's Hospital on Wednesday with back pain. She found out she was pregnant on December 18.
After the scan results appeared, Miss Chamberlain said doctors and nurses "kept asking each other if they were babies who were close together - or 'something else'.
Please click HERE for my class in "How to break bad news"

"Then the emergency obstetrician was called and he took over. He said my babies only had one body and were joined very high up."

She added: "Some might think my twins are strange, but to me they're just special. Everything happens for a reason. Mike and I have spent over seven years trying to have children and we might not get another go."

Ahhhh...sweet

And of course,heaven forbid you should consider adoption?

Another 'Word of the Day'

"Horrigami"

A point reached in certain activities - the folding of a map , the untangling of a kite on a mercilessly cold and windy day - where it seems concedivable that you will be trying to accomplish this one task for the rest of your life on earth.

In my case , trying to get an accurate 'previous medical history'...or even an explanation of the presenting injury that bears any relationship to what I can see on the X-ray...or even...

...well...last week, despite showing a patient her very nasty head-of-humerus fracture,she insisted that it was her wrist that was the problem and not her shoulder...despite having no recollection of how she sustained her injury...having a completley normal wrist film...and being unable to move her shoulder at all...in the end I just got up and left the room and sent Julian in to sort out her fracture clinic appointment...

*sigh*



From "Wyse Words" by Pascal Wyse in the Guardian , 27 December 2008

South African Army elbow stress test

Another bitterly cold Sunday...the heater in my flat is broken ;the heater in my car just can't cope with the snow and ice;and finally when I get to work,the air-con in the Unit can't cope with the weather either.Its 15*C in the Unit.

So I am sitting miserably in my consulting room , listening to my iPod , wrapped in a blanket and praying for a hot,feverish child to examine so that at least I can warm my hands...

I am also trying to get my metabolism restarted-I have been sucking on oxygen for 10 minutes and Julian has made me my 'HeartStarter' morning brew - a cappuccino with 4 shots of espresso and 12 spoons of brown sugar.

Its not really working.

'Alright then Lucien ?' says Julian. 'Here's a patient for you to see then...chop-chop...it'll warm you up!'

A young, tall, deeply tanned , very fit and good looking surfer-dude follows Julian into my room. He is casually dressed in bleached jeans and is only wearing a T-shirt and light linen jacket

( Did I mention - I hate young people! )

He is accompanied by a gorgeous young blond Barbie-doll of a girl,who is also tanned and is fashionably dressed in a faux-fur jacket and a slinky little top, straining her enormous breasts -her nipples look like toothpaste caps.

And like a mongoose with a cobra, I am rather transfixed by the nipples.

I can feel that my red blood corpuscles are starting to get up and trudge around

'Har-umph !!' Julian clears his throat, throws me an evil smirk and flounces out of the room.

"Right...good morning Sir...what can I do for you today then ?"

Well...what it is...obviously...I have been on holiday in Hawaii for three months...surfing and kayaking with my girlfriend here...

"Yersss...right...so unless you have been sent here by my ex-wife to torment me , I'm not really sure what the problem is ?"

Well...Hawaii wasn't the problem...the problem is, is that we flew back to England yesterday...

"Right...so what...you're looking for a referral to the psychiatrist then ?"

No...no...what it is...I was unpacking my suitcase last night and I felt a 'click' in my right elbow

"Okay...was it painful at all ?"

No...no pain...I just heard the one click...but I'm worried because I have to go back to work on Monday...

"Right...what work do you do then ?"

I'm a male model

(Bast*rd ! )

His elbow is not warm or red or swollen.He has a full range-of-movement with no bony pain or discomfort, in his right elbow...ditto his right shoulder and wrist as well. He has no neuro-vascular deficit.

In short , he has a perfectly normal elbow.

(No...I really HATE young people )

"Right ...well Sir...I can't find any thing wrong...I think that you have a mild tendonitis that just flared up last night "

Oh...but what about the 'click' I heard...I'm really worried by that...is there no other test you can do ?

"Well...when I was in the South African Army Medical Services we did have some specialised 'combat-readiness' tests that we used...."

"But I don't normally do them because the patient needs to be really really fit...they are designed to stress a joint to its absolute maximum...but if you could do the three tests then I can give you a gold-plated guarantee that there would be nothing wrong with your elbow "

Ok...well I'm really fit after three months of surfing so I'm willing to do the tests then...

( No honestly...I really hate young people )

"Now because I don't normally do these tests , would you kind if I demonstrated them to my colleagues ?"

No...that's fine mate...

We are joined shortly by the two other South Africans, OumaElna and ChakalakaCindy...and even Ugly Julie, the token miserable New Zealander joins us

"Right Sir...in the first test,I want you to stand up and place your hands together in front of your face ...that's right...just like the Dalai Lama does Sir "

"Now...what you need to do then , is to clap your hands together very fast...in fact you need to clap your hands together 100 times in 60 seconds...okay ?"

Yes

Tongue slightly protruding and with a bit of a squint he starts to clap and successfully manages to complete the task in time...amazing!

"Well done Sir...any pain in your elbow ? Did it click at all ?"

No , it feels good

"Okay...in the next test I want you to place your hand on your stomach . Now...you need to rub your belly-button and then lift your hand up and over your head and pat the back of your head...like this...okay...and you need to do 80 of those movements in 60 seconds...and ...Go!"

Rub/pat...rub/pat...rub/pat..rub/pat

Again he is able to complete the task in time
Again he has no pain in his elbow.

"Right..the third and final task is to combine the first two tests..."

At this point OumaElna says that her pager has just gone off, and she needs to go and operate , and choking back a tear, she leaves the room.

"Right then Sir...so...you need to clap your hands...and then rub your belly-button... and then tap the back of your head...okay...and you need to do 60 of those movements in 60 seconds....and...Go!"

Clap/rub/pat...clap/rub/pat...clap/rub/pat...clap/rub/pat

Again he successfully completes the test. Really amazing .I've never seen that done before.
Again,he has no pain in his elbow.

"Well...that's excellent Sir...I can guarantee that there is absolutely nothing wrong with your elbow...you have demonstrated that you have complete pain-free range-of-movement in every possible plane...honestly...go home and relax now."

Wow...you South Africans are really thorough , he says putting on his jacket

"Oh jah"

So you were in the Army ? he asks, looking at my middle-aged, overweight and frankly distressed body encased as it is in a dishevelled scrub suit.

"Oh jah "

"We had a unique regimental motto you know "

Oh yes...what was it then?

"The devil makes work for idle hands"

Sugar coated life

The first day of the New Year...and yet again I find myself at work...

( Note to Self:- get a life! )

Bitterly bitterly cold , ice on the car this morning, and on the newspapers of the homeless people lying in the doorway of the Unit... and as I survey the packed waiting room,I cast my mind back to other New Year shifts...in Johannesburg in 2001,wrestling on the floor with a blood-slippery head injury patient who had tried to hit a colleague...helping to perform a thoracotomy to save the life of a policeman with a gunshot chest...and saying to a TV crew,that the Johannesburg Trauma Unit was the busiest place in the world that night...apart,-maybe-,from Afghanistan.

*sigh*

The good old days...what challenges will come my way today , I wonder.

"Ms Heidi Vodka?"

From amidst the seething, coughing and spitting crowd of assorted hungover and vomit-covered maligners...most of the patients have not gone home but rather have come straight from their Bacchanalian excesses...a young woman heaves herself from her chair and lumbers towards me.

She is clinically obese.Life threateningly obese.

The sort of obese that is no longer a lifestyle issue but is becoming a lifestyle-limiting issue.
And she is clearly unconcerned because she is holding an Egg McMuffin in one hand a can of Coke in the other.

She has successfully won her battle against anorexia.

And she has a cold...the same cold that I have.Indeed,that most of my colleagues have.That virtually all of the patients in the last 4 weeks have had.

Her cold is exacerbated by the vast amount of alcohol she has consumed in the preceding 12 hours...she is very hungover.

After a diligent and thorough examination...during the course of which the head of my stethoscope virtually disappeared into the fat of her chest wall...indeed,there was a small 'pop' when I pulled it out...I advise her that she has a viral URTI.

Oh...so what can you do for me?

(gee...I don't know...gastric bypass perhaps...give you my copy of 'Dieting for Dummies' )

"Well...nothing really to be honest...you need to take plenty of fluids...and take regular paracetamol and ibuprofen....just let it burn itself out..."

Oh...but I can't take ibuprofen!

"Oh...why not...I asked if you were allergic to anything...or had asthma...indeed had any medical problems...and you answered 'no' to all the questions?"

Well...my friend told me that the ibuprofen are covered by a hard sugar coating...

"Yersss....and ?"

Well...I'm thinking about starting a diet...and think of all the extra calories that I will take in if I take the tablets then...I'll put on weight!

Dear Lord...what I wouldn't give to be in a combat zone again!

I know its all a cliche but Happy New Year

The paradox of our time in history is that we have taller buildings but shorter tempers, wider motorways, but narrower viewpoints.

We spend more, but have less, we buy more, but enjoy less. We have bigger houses and smaller families, more conveniences, but less time.

We have more degrees but less sense, more knowledge, but less judgment, more experts, yet more problems, more medicine, but less wellness.

We drink too much, smoke too much, spend too recklessly, laugh too little,drive too fast, get too angry, stay up too late, get up too tired, read too little, watch TV too much, and pray too seldom.

We have multiplied our possessions, but reduced our values.

We talk too much, love too seldom, and hate too often.

We've learned how to make a living, but not a life.

We've added years to life not life to years.

We've been all the way to the moon and back, but have trouble crossing the street to meet a new neighbor. We conquered outer space but not inner space. We've done larger things, but not better things.

We've cleaned up the air, but polluted the soul. We've conquered the atom, but not our prejudice.

We write more, but learn less.

We plan more, but accomplish less.

We've learned to rush, but not to wait.

We build more computers to hold more information, to produce more copies than ever, but we communicate less and less.

These are the times of fast foods and slow digestion, big men and small character, steep profits and shallow relationships.

These are the days of two incomes but more divorce, fancier houses, but broken homes.

These are days of quick trips, disposable diapers, throwaway morality, one night stands, overweight bodies, and pills that do everything from cheer, to quiet, to kill.

It is a time when there is much in the showroom window and nothing in the stockroom.

Remember, spend some time with your loved ones, because they are not going to be around forever.

Remember, say a kind word to someone who looks up to you in awe, because that little person soon will grow up and leave your side.

Remember, to give a warm hug to the one next to you, because that is the only treasure you can give with your heart and it doesn't cost a cent.

Remember, to say, 'I love you' to your partner and your loved ones, but most of all mean it.

A kiss and an embrace will mend hurt when it comes from deep inside of you.

Remember to hold hands and cherish the moment for someday that person will not be there again.

Give time to love, give time to speak!

And give time to share the precious thoughts in your mind.

And always remember that your life is not measured by the number of breaths you take, but by the moments that take your breath away.

George Carlin , as quoted by Bobby Brown on radio 702*Talk radio out of Johannesburg on 23 December 2008