YummyMummy

We don't get very many YummyMummies in this part of Little England...indeed,most of the local women are difficult to distinguish from their men...they are as dumpy,as dirty,as dull,and have as many tattoos as each other.Both groups wear ear-rings,cheap track suits and its often difficult to distinguish a beer-belly from a pregnant belly,particularly as both groups drink the same vast amounts of alcohol.

And so...yesterday I was pleasantly surprised to see a young clean...even attractive YummyMummy come in with my first patient after lunch,a young boy of three with a head injury, called Caleb.

His mother introduced herself as 'Brunhilde' and spoke excellent if slightly accented , English.

Now I am a sucker for feminine women...wear a ribbon in your hair...or wear a floral patterned summer frock...and I'll ask you out to dinner.

And if ...Heaven forbid...you are clean and your hair smells of apples...well then I'll even give you a prescription for codeine!

Caleb's mum had both the ribbon and the floral skirt;as well as a white cotton blouse.

Now there are various ways to check all the things you need to in a child with a head injury...to check that the wiring and carpentry as well as the brains' plumbing are all functioning to the makers-spec's.

Like everyone else,I've developed my own ways...one of them...with younger children involves then dancing with me on their tiptoes and then their heels and then getting then to squat down and jump up.

"Okay Caleb...can you stand on you tiptoes for me?"

I don't think he knows how to do that...let me show him

With that,Brunhilde stands up,slips off her sandals,and stands on her tiptoes and then starts to jump up-and-down on the spot...I'm not really sure why.

It was at that point that I realised that no matter how pretty her blouse was,it neither supported nor constrained...but rather just framed... her frankly magnificent mammary apparatus...which started to jiggle up and down.

Both Caleb and I looked on with admiration.

"Okay...can you squat down for me....like you're looking at something on the ground?"

I don't think he knows how to do that either...Caleb...do you remember how grandfather does the 'bunny jumps'?

He shook his head slowly.

Let me show you.

With that,she pulls up her skirt revealing very long,tanned,muscular legs...she then squats down...leans forward...and starts to bunny hop towards me.

And about 10 lbs. of hand-reared, organically-fed, free-range, A-grade, prime-cut , alabaster-white, slightly-freckled, lightly-sweating, firmly-toned, independently-sprung; and well-moisturised breasts came bouncing straight at me...

Julian,who had chosen that moment to enter the room to bring me my afternoon beverage,stopped...spluttered...Here Lucien...and thrust the cup of tea at me...and red-faced,scuttled out of the room.

Her son,in the meantime had stood there calmly watching her,and steadfastly refusing to take part...

Shall we try that again then Caleb?

(Please...oh dear Lord...PURLEEZE let her try that again!!!!)

And so,holding hands,both of them started to hop down the room towards me.

(Lordy Lordy...will someone get me my Ventolin!!)

How was that then?

"Ma'am...honestly...I'd pay good money to see that at the movies"

I meant...how did Caleb do...did he pass the test...!!!

"Oh...jah...he did just fine..."

Some days the Universe just sends you a present...don't fight it!!

Why we eat...

As regular readers will know,I am a huge fan of AA Gill,the restaurant critic of the London "Sunday Times".

Yesterdays column was inspiring and so...as always...I have no hesitation in sharing with you all,what was for me,both beautiful writing and original thinking.

Enjoy!

The plates came, the forks hung over the table like metal herons in a linen pond, and we ate first for hunger, then for curiosity, and finally for just the marvellous joy, the deep, deep pleasure of eating.

It is the first human rapture we ever experienced, the most ancient foundation of all culture and civilisation; our spirits are lifted, the table becomes the basket of a balloon that rises above the care and grind.
You look down from lunch at the patchwork of your life stretched below. Nothing so elevates the mood and butters up the world like lunch.

And I remembered a great truth I was once told by a cheese-maker: you can’t be an optimistic butcher, and you can’t be a pessimist and a good cook. That’s absolutely right.

Cooks are optimists, or they’re not cooks. The act of cooking is hopeful; the ritual of creating life out of death, of making breath and brains out of muscles and roots.
Food is the future concocted magically out of the past.

Every time you beat the olive oil into the egg yolk, and it thickens and pales and glistens, you know that the egg will go on and on making mayonnaise longer than your arm can beat it.
Nobody has ever got to the end of a yolk’s ability to make mayonnaise; it is infinite, a kitchen spell of infinite hope, the promise of endless potato salad, poached salmon, dipped crabs’ claws, gulls’ eggs, ham sandwiches, chips, and chips.

Read the full article at the Times Online site at :

http://www.timesonline.co.uk/tol/life_and_style/food_and_drink/eating_out/a_a_gill/

"Come on and leave me breathless"

The first patient of the day was a middle aged man who said that he was asthmatic and that he felt short of breath.
He also told me that he was on his honeymoon in our little town ,- (clearly needs a psych referral then!!)-,and that he had accidentally left all of his medicines at home...naturally,he didn't know what medicines he took apart from the salbutamol inhaler...mainly I think because mine was on my desk.

He presented a sorry sight.His hair had clearly last been cut using a pudding bowl about 2 years ago-and that was about the same time it had last been washed as well;he was wearing the obligatory white England football shirt down the front of which was fetchingly displayed his breakfast coffee and porridge.
He was also,ineffectually using one crutch...it turned out he had arthritis in his right knee...
And he was wearing sandals with white socks.

(I idly wondered why his wife would let him go out in public dressed like that...surely one of the key advantages of actually surrendering your freedom and entering a lifetime of financial servitude,-ie,getting married-, is that you will have someone to make sure that you look and behave like a normal human being when you go outside the house?)

After a full and thorough examination I decided that whilst his chest felt subjectively tight ,that objectively,his shortness of breath had as much to do with the changeable weather as anything else...we had just had a run of a hot dry day;then a hot wet day;then a cold dry day;followed by another very muggy hot and humid day.
Indeed his sats were 97% on room air and he was blowing 520 on the peak flow-meter which was 80% of his expected best effort...well...according to my Archimedes anyway.

So I decided to give him back-to-back ventolin 5 mg nebulisers;followed by an ipratropium 5mg nebuliser.
And lo...he felt all happy and cured!!

As he was about to leave he asked if I would like to see a photo of his new wife...explaining that he met her when she had been sent by the local council to be his carer.

In fairness he said that he had been able to be weaned off of all the many exotic psychiatric drugs that he had been on...*sigh*...the power of love!!

He pulled out his Benefits-funded iPhone and scrolled up her photo.

I looked at it...took off my specs and cleaned them...looked at the photo again...
...and referred him to the ophthalmic surgeons for an urgent appointment .

Suffer the little children...

I've written before about Social Services and the less-than useless service that we get from them in our area.

And in a week in the UK when social services were once again 'exonerated' for their role in the death of another child , Brandon Muir ,at the hands of his mothers' "partner" ,we had yet another problem at work .

A 3-year old boy was brought in by his mother on Monday evening...at 2030...because she thought that he may have drunk up to 100mls of mouthwash.She had phoned Poison Information and had been told to go straight to St Vulva's due to the possible toxicity of the fluoride in the reported quantity of mouthwash.

Now it was difficult to know if the lad really had drunk the mouthwash...except to say that his breath smelt 'fresh 'n minty'...as did his pyjamas.

She of course just couldn't be bothered to make a (free) phone call to get a (free) ambulance.

Instead,she bundled the child into a pram,and walked to our Unit.

The triage Nurse,the ENP looking after the child and I all recognised both the mum and the toddler.And their names were flagged on the computer with "special notes".Now the 'notes' can and do say lots of things including quite innocuous remarks about referrals and treatment plans....but they are typically used to highlight nutters or children at risk.

She had been in the Unit 2 months ago with burns to her arms and hands...she told us then that her son had tried to set her alight whilst she was having a little nap...in fact he had also been burnt...and her main concern that evening was getting treated as quickly as possibly as she had a date!

In the past few months her son had also been brought in having sustained a minor head injury after being allegedly assaulted by his father,a known paranoid schizophrenic,in an incident in which the police had been called.

Additionally , he had also brought in with D&V after having apparently eaten raw mince.

The ENP looking after him pulled up his notes and found that urgent referrals had been made to Social Services requesting 'immediate action' on all three occasions.

Surprised that he was still at home with his useless single-parent,teenage mother on benefits, she then pulled up the SS notes...only to find that on all three occasions,that Social Services did not think that the child was at risk for physical or mental abuse and so declined to look any further into the home situation.

You couldn't make it up !!

Fortunately this time,he warranted another admission to the Peads service...so perhaps he will be properly assessed this time....although I'm not going to be holding my breath since they have done bugger all to protect this child in the past.

No wonder I'm taking so much sick leave!!

Diet Q&A with Lucien

Q: Lucien, I've heard that cardiovascular exercise can prolong life. Is this true?
A: Your heart is only good for so many beats, and that's it... don't waste them on exercise. Everything wears out eventually. Speeding up your heart will not make you live longer; that's like saying you can extend the life of your car by driving it faster. Want to live longer? Take a nap.

Q: Should I cut down on meat and eat more fruits and vegetables?
A: You must grasp logistical efficiencies. What does a cow eat? Hay and corn. And what are these? Vegetables. So a steak is nothing more than an efficient mechanism of delivering vegetables to your system. Need grain? Eat chicken. Beef is also a good source of field grass (green leafy vegetable). And a pork chop can give you 100% of your recommended daily allowance of vegetable products.

Q: Should I reduce my alcohol intake?
A: No, not at all. Wine is made from fruit. Brandy is distilled wine, that means they take the water out of the fruity bit so you get even more of the goodness that way. Beer is also made out of grain. Bottoms up!

Q: How can I calculate my body/fat ratio?
A: Well, if you have a body and you have fat, your ratio is one to one.. If you have two bodies, your ratio is two to one, etc.

Q: What are some of the advantages of participating in a regular exercise program?
A: Can't think of a single one, sorry. My philosophy is: No Pain...Good!

Q: Aren't fried foods bad for you?
A: YOU'RE NOT LISTENING!!! ..... Foods are fried these days in vegetable oil. In fact, they're permeated in it. How could getting more vegetables be bad for you?

Q: Will sit-ups help prevent me from getting a little soft around the middle?
A: Definitely not! When you exercise a muscle, it gets bigger. You should only be doing sit-ups if you want a bigger stomach.

Q: Is chocolate bad for me?
A: Are you crazy? HELLO!! Cocoa beans !! Another vegetable!!! It's the best feel-good food around!

Q: Is swimming good for your figure?
A: If swimming is good for your figure, explain whales to me.

Q: Is getting in-shape important for my lifestyle?
A: Hey! 'Round' is a shape! Well, I hope this has cleared up any misconceptions you may have had about food and diets.
And remember: 'Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well preserved body, but rather to skid in sideways - Chardonnay in one hand - chocolate in the other - body thoroughly used up, totally worn out and screaming 'WOO HOO, What a Ride'

Angels and Demons

The young female patient had two problems:-
firstly,she claimed that her drink had been spiked;
secondly,she had bilateral foot injuries.

She wasn't sure which drink had been spiked...it was either her 10th vodka&coke (which was in fact her 12th drink of the evening)...or if it was the 13th drink she had consumed,a Jack&coke.

(Man...that coca-cola can make you sick,hey?)

Anyway...when she awoke fully dressed , (albeit wearing vomit stained jeans) and in her own bed the following morning, with her fully dressed boyfriend next to her,she found that she had wounds to both her feet.

On each instep,there was a small square wound...a perfect square,about 1,5cm in diameter...and about 0,25 cm deep...there was some loss of skin and the wounds were a little bloody.

She was partial-weight-bearing through her left foot;and non-weight-bearing through her right foot.

She was sitting in a wheelchair when I went to examine her.

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

Well...its my feet...look at them....I woke up this morning and they had them holes in them,didn't they?

"Uh huh...okay...can you please show me the palms of your hands?"

Why?

"Well...those wounds in your feet look like stigmata...so if you have them in your hands as well,then I'm afraid to tell you that your drink was spiked by the Devil...

....and you are probably the Anti-Christ...so....before I rush off and phone Dan Brown,I'd just like to look at your hands if I may..."

Who's Dan Brown then ? Yer boss?

"Umh...no"

She didn't have any wounds to her hands...I wasn't really expecting to see any....but in this town...you just never know!

After a thorough and diligent examination which included taking an x-ray of the most painful foot,and after finding no bony injury,I called the ever trusty Julian ,in to clean and dress the wounds.

"So...Julian...have a look at those wounds...I'm not sure what caused them...could you please just clean them and pop on an inadine dressing?"

Julian looked at me;at the patient;at her badly dressed boyfriend;and then back to me.

Was you out clubbing last night? he asked the patient

Yes...we was at 'Sodom and Gommorah'

Well....I have 3 words for you...Christian Louboutin stilettos

"What !?!"

Yerh...wot?

I've seen this before Lucien...if you have an argument in a club with a woman wearing high heels,she'll come back and jump on your feet when you're not looking...


Julian...my own tame little diagnostician.Who knew?

House : One / Julian : One

Location ! Location ! Location !

The young man had shuffled into the Unit and declined to sit,asking if he could lie down instead...

"Sure you can...what seems to be the problem then?"

Well....what it is...I was at the beach yesterday with a friend...and we spend the afternoon drinking and ....you know....messing around...it was very hot yesterday....and ...ammh...we had some ice lollies...

"Uh huh....wine and 'ice lollies'...sounds like the epitome of romance...And?"

Well...we went out for dinner and then got back home and had some more wine....and then we went to bed...separate beds because we're just friends...

*sigh*

"Jah...and then?"

Well...I woke up this morning and found my friend in bed with me...

"Yerrsss...?"

And she said that I had stuck an ice lolly stick up my bum...!!!

"I see...do you remember doing it?"

No

"Can you think of any reason why you might have done it ? Is it a sexual thing for you?"

NO!!
I don't know why I did it....

"Was it because there's a shortage of rubbish bins on the beach perhaps...and your hands were possibly full with bottles of wine ...and so you thought you might just pop it in your bum ...umhh...so you could take it home to throw it away?"

NO...she says that I definitely told her that I did it when we were having sex...but I don't remember having sex either...?!?

"Riiiggghhht...well...of the two issues,I think that having no memory of getting into bed with your friend and having sex is probably more of a problem than the stick..."

Yes...but the stick seems to be stuck inside somewhere...I've been to the toilet three times this morning....and it hasn't come out yet!!

So...can you please examine me to see if its still inside?

"Uh huh....that's what you want? Well...let me just check my PDA...I'm sure I have a program that deals with these situations....so...(TAP TAP TAP)...the answer to that is ...umh...NO"

But when the on-call surgeon had finished accusing me of winding him up and had stopped laughing,he said 'Yes'.

Brave man.

amaCeltic

Now I've attended more than my fair share of faction-fights...as a Peace Monitor with the Wits-Vaal Secretariat...as a Hostage Negotiator...and of course as a flight nurse and as a paramedic.

They were always interesting.

You cant believe what an Okapi penknife can do...hummh...perhaps I should get my blog sponsored by Okapi?

I was always a little nervous in those situations...it should be no surprise for you to learn that Jo'burg Fire department,-where I was employed as a Nurse-Paramedic-,had its own armoury of 9mm pistols and shotguns.

Anyway...you sort of think that when you leave Jo'burg that you leave all the faction fighting and tribalism behind...but of course,you don't...it just takes a different form.

Last night a patient came in with massive facial injuries including a fracture to the bones around his left eye with some loss of vision;some broken ribs;assorted cuts and grazes;and was mildly concussed.

He was wearing a (bloodstained and torn) Celtic football club shirt.This is apparently a Scottish , Roman Catholic -supporting club...their arch-enemies are apparently Rangers...a Scottish,Protestant supporting club.

Now these two groups hate each other with a senseless energy ,an unconscionable ferocity and unjustifiable viciousness that leaves most anybody with a brain...or any rugby player or supporter...frankly,speechless.

(Who knew people took football so seriously...its such a girls' sport...no offense girls...because you know that I am all in favour of 22 fit young women in shorts running around,getting sweaty!)

This man was a tourist and was keen to watch a football match on TV between two European teams... now one team is supported by Celtic fans,and the other is supported by Rangers fans.

In his confusion,and having already consumed half a bottle of no-name Vodka,and with a tremendous thirst,he wandered into a Sports Bar full of Sky News Large screens to watch the game.

Big mistake...it was full of Rangers fans...

...who without warning immediately,-and with malice aforethought-,promptly beat the man to the ground.

Fortunately the bouncers intervened and threw him out onto the pavement...

...where fortunately a caring passerby offered him a swig of methadone to help with the pain...

...unfortunately the Celtic fan then drank the entire dose of methadone and was then further assaulted by the hitherto Good-Samaritan junkie

...and so he came in drunk,hallucinating and with a rapidly slowing heart rate ...

...where unfortunately he met me...And all he wanted to know was...what was the final score...

So I told him...."Idiots : Nil, Racial and Religious Bigotry : One"

To have...and have not

I saw a young boy of five,Harry,who had been brought in by his aunt having sustained a 'head injury' whilst playing hide-and-seek with his cousin.He had a tiny little wound to his forehead which didn't really require any treatment although I got Julian to put on a single Steristrip so that the boy could have some 'bragging rights'.

We have a head-injury protocol here that requires quite a significant examination and serial observations over the course of an hour.So I initially saw the child when he was being seen by the Triage nurse;then examined him a short time later;and then saw him when he was ready for discharge.

The process involves taking the standard medical history; a social and psychological history;a physical examination of things like cranial nerves and pupillary reaction to light,etc;some cognitive testing;and a reflection on the findings filtered through your experience.

He was what is called 'a well presented child'...clean,polite,well mannered,well dressed...and his aunt,and six year old cousin were the same.His aunt explained that he was staying with her family for a few days as his parents were relocating to the UK from Europe and needed some space to sort out the new house.His cousin was chatty and inquiring and keen to have his own cranial nerves checked .

During the exam I had a vague sense that I was missing something...he was answering all my questions correctly...he was able to do all of the age-appropriate cognitive tests that I asked him to do...(my PDA is just loaded with those sort of programs)...and he was able to preform all of the physical tests that I undertook...and he did it all with grace and determination...but it felt like he was working a few seconds slower than I would have expected...talking to him was as if we were on a time-delayed phone line...

And he wasn't keen to look at me or his aunt...

Most worryingly,when I wasn't doing anything to him or with him,he sat quietly on the bed,holding his hands straight up in front of his face,fingers pointing skyward...and moving them as if he was playing the piano to a manic tune only he could hear...

I asked his aunt if he was usually this quiet and self absorbed,and his cousin chirped in...

You have to ask him two times if he wants some pizza!!

"Uh huh...tell me Harry...do you like computer games?"

He nodded.

His aunt said that he spent a lot of time playing on the computer.

I looked at my notes again and then asked the boys to wait outside with their grandmother who had accompanied them to the Unit.

"Ma'am...does Harry have any brothers or sisters?"

Yes...he has a younger brother...he's 4...

"Is he in a normal class at school for a child of his age?"

I'm not really sure...because they have been in Europe...but why do you ask?

"Well...I cant find anything that bothers me in terms of the head injury...obviously you'll need to keep an eye on him for the next 24 hours...but....hummh...well,he just seems to be a little self-absorbed...and a little 'slow' in his responses....hummh....I don't mean to be offensive or alarmist....but I can't help wondering if Harry is perhaps mildly autistic...?"

Slowly,silently,his aunt started to cry...her eyes filling,the fat teardrops spilling over and rolling down her cheeks.

"I'm sorry..."

She reached out and gripped my hand.

I let her cry for a few minutes.

I knew...I knew

His brother is profoundly autistic....I knew that Harry was autistic ,-I'm a teacher-,but I didn't want to believe it...

...or to bother my sister...his brother takes up so much time and effort and money...that's why they are coming back to the UK...

We sat for a few moments.
And then she took the kids home.

Sometimes...in the middle of an ordinary day...you find that you've given a family a life sentence...

You just have to try and act with grace.

Sex in this City

So there I was in my consulting room,with a 14 year old girl -who is the patient-,and her mother.
They are both chewing gum and are both displaying more flesh than I would hope for just before lunch.

The girl has a really bad strep throat,fulfills all the criteria for antibiotics, and so I am about to give her a course of Penicillin.

She is however,-and although she is only 14-,already on the oral contraceptive Pill.

Now there is a lot of debate about the possibility of adverse interactions between antibiotics and the Pill,where basically,its thought that the antibiotics could stop the Pill from being effective and working properly.
Some say there is no effect;some say there is an interaction.

In our Unit,in our Health Authority Area,and given the problems attendant to an unsought pregnancy,we tend to err on the side of caution...

"Right...here are the antibiotics I would like you to take for the next seven days...now...just to advise you...you may not be covered by your Pill for the rest of this cycle...and all of the next cycle...Okay?"

What do you mean...I won't be covered?

Yeah...what do you mean?? says the alleged mother

"Well...its thought that the Penicillin can stop the Pill from working properly...so if you are going to have sexual relations with someone else,then you need to use an alternate means of birth control...Okay?"

What do you mean...'alternate'?

"Well...a condom..."

Well I don't like using condoms...and my partner doesn't like them either...!

(Her 'partner'...?)

Yeah...she doesn't like using condoms!!

So what am I supposed to do then...huh??

"Well...perhaps you could just pretend you are actually 14 years old and NOT have sex for six weeks...how does that sound...?"

But its the holidays!!

Yeah...its the holidays!!

"Gosh...aren't you a little 'black-hole of need'..."

"Okay...here's a phone number for you...its the Chaplain...phone him and see if he cares...have a nice day now...somewhere else."