The Award for 'best attempt at a credible explanation' goes to...

Last Sunday we decided to bestow our own version of the Darwin Awards to the patient with the weirdest explanation or excuse given for their injury .

All the shortlisted candidates were male!

In third place:-

Patient reports that on Friday night ,-in drink-,wearing trainers,that he attempted to kick his front door down because he couldn't find his keys.He continued to kick the door until the pain in his toe became unbearable and he fell over.

He had a bruised toe with no bony injury.

In second place:-

One week ago,whilst running through a garden (which may or may not have been his own) the patient may (or may not) have been stabbed in the right calf with something that may (or may not) have been metal and which may (or may not) have broken off inside his leg and which may (or may not) still be in his leg.
He reports that he developed a scab which he peeled off yesterday and that he has squeezed out a lot of green pus.Today his calf is warm and red and swollen and painful.

He was apparently trying to out-run the police!
And succeeded!

And the winner of the prize for the most unbelievable and bizarre explanation goes to this young man:-

Patient reports that he has lost his memory.Reports that the last thing he remembers is being on his computer on Friday evening ;and that the next thing he reports being aware of , is when his phone rang at 11am today {on Sunday morning} and his girlfriend wanted to know where he had been for the past day.He reports that his left arm is swollen and blue and very painful,and that his left hand is also swollen and blue and feels numb and icy cold.He denies taking any drugs or drinking any alcohol.

He had no obvious fracture on the very quick x-rays that were done but had a really bad compartment syndrome in his arm with a threatened hand that required an emergency transfer to St Vulvas' and immediate surgery!!

The Orthopods are beginning to really dislike me...

Outstanding!!

He decided to forgo the free enema which was First Prize...second prize was two enemas...and third prize was ...well....three enemas.

The South African Army Kwik-Khiropractic-Kure

"Mr Kant-Keypittup ? Mr Hugh Kant-Keypittup ?"

A tall ,pale , grey-looking middle-aged man,with long lank hair,and dressed by the Salvation Army Corps of Stylists,unfolds himself from his chair,and,-with both hands on his lower back and leaning forward-, he shuffles ever-so-slowly into the Unit.

"Take your time Sir....they pay me by the hour..."

Finally he reaches my consulting room and collapses into the chair.

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

And he leans forward and exhales directly into my face...!!!

There's only one thing I hate more than a patient coughing over me...and that's when they are trying to convince me of how much pain they are experiencing and perform these long sighing exhalations of supposed pain...

Well ...what it is ...obviously...I bent over to pick up a coin from the floor and felt my back 'go'...and now I have pain in my back and can't walk properly...or stand up straight...

"Uh huh...now...I need to ask you some strange questions Sir...they may sound like I'm making them up...but I assure you that they are absolutely critical....so....tell me...are you able to pass urine...and can I check that you've not lost control over your bladder or bowels?"

[There are a number of what are called 'Red Flag' symptoms that would indicate a serious injury with a poor outcome if the patient had any positive signs...and no matter that he walked into the Unit;and no matter how relaxed I am,you can just never afford to be complacent]

What do you mean...my bowels?

"Has your stomach worked today? Have you had a cr*p?"

Oh...yes

"And you have't lost control over your stomach? "

Oh...no...I don't think so...

*sigh*

"Okkaaayyyy...does your bum feel numb ? Do your testicles feel numb?"

What do you mean...feel numb?

"Well...really...just what I said...if you were to squeeze your testicles, -better yet...to pinch your scrotum-,does it feel numb ?"

I dunno what you mean...

I take his left hand and after warning him what I am going to do,I pinch the skin on top of his hand...unsurprisingly,he says...Ouch...and pulls his hand away

"Okay Sir...now...if you were to pinch your scrotum,do you think it would feel like that just felt...or do you think that there would be no feeling?"

Well...I dunno...

"Well Sir...perhaps you could just pinch your scrotum now and tell me what it feels like?"

Don't you want to do it for me?

"I'll pass thanks..."

And so he leans back in the chair...closes his eyes...sticks his hand down the front of his grubby trousers and starts to root around...like a pig sniffing out truffles in a forest in Provence...and slowly...a beatific smile starts to settle on his face...

(This isn't a hospital...it's the waiting room for Hell...with fluorescent lighting...)

"Okay...Sir...Sir...you can stop now...SIR!!"

Slowly...very slowly...he withdraws his hand ,flexes his fingers and opens his eyes...

No...I didn't feel anything...I'm sure my balls are numb...you'd better check...

"Really...you've no idea what sensation you just felt...and you're really asking me to have a feel?"

Yerss...

"Right...okay...stand up please Sir...what I'm going to do then is to squeeze the back of your scrotum...where it comes out of your perineum...okay...tell me if you can feel that when I pinch that then..."

He stands up...and as I put on some examination gloves...he drops his trousers...unsurprisingly,he isn't wearing any underpants...
And looking at his withered haunches and his dessicated and ill-formed dangly man-bits,I decide to put on a second pair of gloves...
After all,lunch is only an hour away...

I cup his testicles in my left hand and reach out with my right hand, and grasp the back of his scrotum firmly between my thumb and forefinger...he continues to exhale all over my head...

"Right Sir...are you ready...now...tell me if you can feel THIS!!!"

His head jerks up...his shoulders arch...his arms fly back to the side...and his spine straightens,-ramrod straight-, as he emits a high keening scream...

Julian...always on the lookout for a little S&M , no matter how vicarious, stuck his head through the door....

'Alright then are you Lucien...can I get you anything...Oh...would you like a vomit bowl Sir?'

"We're good thanks...so...can I just check that you felt that then Sir...?"

Wiping the tears from his eyes,he acknowledges that he indeed felt the pinch...and then notices that he is standing upright...

Gosh...that's alright then...look mate...I can stand up straight...that's amazing that is...the pain has gone...how did you do that??

"Ah well...that's a trick I learnt in the Army Sir...there's a little known nerve between the testicles and the spine...some people call it 'courage'...we were taught it as an 'Emergency Field Chiropractic Treatment'...the RSM in training camp called it 'wakey -wakey' "

"By the way...Julian will give you an ice-pack on the way out..."

But my back feels fine...

"Its not for your back...!

Oh!!....so...were you in the Army then?

"Yes Sir...we had a unique regimental motto...

Oh...what was it?

" 'I'm not mean ... you're just a sissy'...Sir"

Conference by the sea

So...off to Brighton for the 'College of Emergency Medicine's ' annual Scientific Conference...a two-day thought-fest...with breaking news from the cutting edge laboratories and resus rooms of modern Britain...

Or something like that...in fact there are five distinct groups at the conference:-

Firstly there are the Junior Doctors who need to present a paper to establish their academic credentials...so that at some point in time they can apply for an enormous government grant to enable them to go off to some warm and pleasant part of the world,replete with cold drinks and warm Jacuzzis to 'research' something of benefit to someone living on unemployment benefits in north Wales.

Secondly there are the Consultants, who have already secured their grant money and done the research and now have to present their findings to improve the lot of us mere mortals at the coal face...who have thus far been unable to secure funding ourselves...

Thirdly are the newly qualified doctors and nurses,-the trauma wonks and geeks-,who are still keen and excited about the prospect of frequently hurting-,and occasionally killing-, complete strangers...and who are desperate to learn something...anything...that will keep them and their patients safe at 2 o'clock on a wet winters morning...little realising that it is only luck and coffee...in equal measures... that stop most of us from killing more of you...

Then there are the 'Middle Grade' and middle-aged doctors and nurses who are there to perhaps learn something...to get some free pens and Journals...to have a paid-day away from the Great Unwashed...and perhaps to get laid...not me personally you understand!!

Finally there are the "Reps"...those crisply suited,gelled-hair and unctuous purveyors of all that is glittery and whose sales pitches are buttressed by scientific papers from the University of Ulan Bator...apart from the two harassed NCO's from the Royal Army medical corps who offer to sign me up on the spot despite my advanced age and general state of decrepitude...and who promise to send me to Iraq next week...as an officer!!!

And so to the research...what gems fell from the lips of the Trauma Gods?

For readers of a nervous disposition,you should perhaps make a cup of warm cocoa...perhaps dab a little eau de cologne onto your hankie...

1. Pedestrians die mostly by being involved in an accident with a vehicle with an engine
2. The more cars that there are on the road,the greater the chance of having a accident
3. The faster the speed of the car that hits you,the greater your chance of dying
4. Acupuncture doesn't work on drug addicts with back pain,who have attended A&E seeking meds to fuel their addiction
5. Proper , professional and diligent examination of older ,sicker patients will lead to a decrease in mortality and morbidity
6. Crazy people need complex interventions
7. Alcoholics who smoke,take drugs and are unemployed do not generally keep appointments with alcohol intervention social workers
8. Domestic violence happens at home between men and women
9. Some patients will die despite having the very best of care...but if they die in the first 6 months of a clinical trial then their death is simply a learning curve and to be expected
10. Its always best to try and diagnose the illness before discharging the patient

So there you have it...verbatim...the latest medical research from the top trauma thinkers in modern Britain...

Actually...that RAMC offer looks a little better now!

Do you know the way to San Jose...

I like women...
I enjoy...-prefer even-... the company of women over men.

(Unless of course I am talking rugby...)
(Or firearms...)
(Or flying...)

I love the way women talk and think and move and laugh...

*sigh*

(Its been my downfall)

In particular I like lesbians.

Indeed I have many, many fine films featuring lesbians...films about lesbians in bikinis on a desert island...lesbian police officers...lesbian firefighters...gym teachers...even nurses...one or two even feature police officers and gym teachers cast-away on a desert island...

Indeed I even seem to frequently date lesbians...or maybe that's just what they tell me at the end of the date...

And of course...like any marginalised group they have specific health needs...

And so,on Easter Sunday afternoon Julian called me to the waiting room to see a patient who he believed needed immediate care...

I saw a young woman with an obviously injured right shoulder.

She looked like Jomo Lomu's better-fed,older brother...dressed in black overalls..with spiky gelled hair...

She explained that she had previously dislocated her right shoulder playing rugby and that she had reached up for a book from a shelf and “felt her arm 'go'”...and that this had in fact happened to her the day before...

Now...in addition to her having a 24-hour old injury,she had also driven past 2 hospitals to come to my Minor Injury Unit! She lives in the next town along called Grinding-on-Poverty,about 20 miles away.

It has a fine hospital,called the Queen Labia Minora Memorial hospital,with an average A&E department...but she didn't want to go there because they had disrespected her on a previous encounter...

Having checked that she was (surprisingly) neuro-vasculalry intact,we X-rayed her shoulder and found she had an anterior dislocation of her shoulder...

*ouch *

“Right Ms Clamdigger...you have a dislocation to your shoulder and I think that you're probably going to need to have some sedation,-if not in fact,a general anesthetic-,to relocate that...”

Can't you put it back...?

“No...honestly...you're unable to move your shoulder through any range-of-movement...I'm afraid that all of those muscles in and around your shoulder have gone into spasm...I'm afraid that I'm going to have to transfer you to St Vulva's A&E...I've spoken to the Ortho-Reg and he's had a look at your x-ray and is basically waiting for you...”

Can you call my friend in...?

“Sure...”

Julian slopes off and returns 2 minutes later with another young lady in tow...she looks like the she played loose-head prop for Free States Country Districts...and is dressed in black battle-dress and sports various rings and studs and chains in most of her visible anatomy.

She strides over to the bed and gives Ms Clamdigger a full-blooded kiss...saliva fairly dripping from her fangs...

(Its really nothing like the videos )

“Okay...well...your friend needs to go to St Vulvas to have her shoulder sorted out...can you drive her?”

Yes...but I don't know where it is...

“Okay...do you have a SatNav of any sort?”

No...

“Okay...well...we have a map...let me show you...”

I don't know how to read a map...

“Do you have any friends we could phone?”

No...

“Well...humm...we could always send you up in a taxi then ladies...”

We're not 'ladies'...we're lesbians...

“Honestly...I didn't know that...tell me...is that working for you?”

"Perhaps you could get a copy of Navigating for Dummies...from www.jou-ma'se-poes.com..."

Let your heart sing...

Just in case you've been living in a cave for the past few days...do yourself a favour and have a look at this clip on YouTube...

http://www.youtube.com/watch?v=9lp0IWv8QZY&feature=related

Read the Huffington Post story at :-

http://www.huffingtonpost.com/2009/04/14/susan-boyle-britains-sing_n_186787.html

Enjoy enjoy!!

Easter Monday Morning

A beautiful crisp spring morning and the patients are queuing at 0730 for our 08H00 opening.

My first patient of the day just looks ...well...crazy...there's simply no other way of phrasing that...

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

Its the snakes...can you get rid of them for me...?

"Humm...what snakes?"

Well...in summer...about 10 years ago...there was a dead adder in the garden...

"Yerss...?"

And it was covered in gnats...and when I went to look at it,the gnats all flew off and got stuck in my hair...

"Jah...and this was 10 years ago?...so whats the problem today then?"

Well...the gnats laid eggs...and the eggs have hatched...I can feel them under my skin...

"So...you feel like you have gnats flying or crawling around under your skin???"

No...no...don't be silly...not gnats...ADDERS...the gnats laid adder eggs under my skin and they've hatched...and the snakes are crawling around inside of me...its been like this for weeks now...

*Lordy Lordy...10 minutes into the day and already I've lost the will to live*

"Okay ma'am...take these anti-histamine tablets...and if you don't feel better by tomorrow morning then make an urgent appointment to see your GP..."

How do I set my stethoscope to 'stun' ?

Easter Sunday Song

Imagine there's no Heaven
It's easy if you try
No hell below us
Above us only sky

Imagine all the people
Living for today
Imagine there's no countries
It isn't hard to do
Nothing to kill or die for
And no religion too

Imagine all the people
Living life in peace
You may say that I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will be as one

Imagine no possessions
I wonder if you can
No need for greed or hunger
A brotherhood of man
Imagine all the people
Sharing all the world

You may say that I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will live as one

John Lennon

Not a very Good Friday

The day had not started well...

First , I woke up and realised that in fact Pamela Anderson wasn't in bed with me...

The new security service didn't know the code to the burglar alarm and when they opened up the building this morning the alarm went off...it is loud,electronic and discordant...and screeched out until 0830 when a technician could finally switch it off.

And then the x-ray system broke down.

The first patient came in complaining that he was bleeding from his rectum...and had been for over 11 months...and he wasn't sure if he had hemorrhoids or not...

I explained that I would need to pull his buttocks apart,look at his bum and possibly even stick a (long and lubricated) finger into his rectum...he declined my kind offer and left...small mercies really as I had only 20 minutes before finished my Egg-and-Sausage McMuffin...

The second patient came in already dressed in pyjamas and dressing gown,his wife clutching a small BOAC overnight bag...unfortunately for him,he had come to the wrong hospital...so Julian organised a taxi-on account-to take him to the correct hospital.
Nice man,sad case.

The third patient came in complaining that she had symptoms of cystitis...a nice quick and easy case...though I did wonder why Julian was sniggering when he brought her to my room and brought the urine sample with her...

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

Well...what it is...obviously...I've got a urine infection...

"Do you have any frequency or urgency ? Does it burn or is it painful when you pass water?"

No...not really...

"Uh huh...okay...I see that my colleague has done a dipstick test on the sample you gave him...and it appears to be absolutely clear...'no abnormalities detected' as we say...he's also made a note that the urine is very clear..."

I pick up the container...which feels icy cold...unscrew the top,and sniff the contents...and then drink some of the urine...

(What she doesn't know is that Julian has swapped the containers...and...'given me one he had prepared earlier')

Horrified the patient stares at me ...

"Right...well I have to say that my ex-wife was frigid but honestly...even her urine came out at body temperature...this is water isn't it?"

Ummm....yerss....well...what it is ...I've got a lot of shopping to do today and I didn't want to wait...so I filled the specimen container with water from the drinking fountain...

(Julian had seen her doing this when he was taking PyjamaMan out to his taxi)

"Right madam...go and wait back outside...here's a new specimen jar...and when you feel that
you can fill it...with urine...do so and give it back to me..."

Ten minutes later shes back with a fresh specimen...a darker coloured orange

"Okay ma'am...well...this is also a bogus specimen isn't it ?"

Umhhh...well...no...I've just passed that sample...

"No you didn't ma'am...."

Well prove it then...!!!

"Firstly... its fizzy!!!"

"Secondly there is so much sugar in it that the test strip has turned green...if this is your urine then you're unconscious and I'm just a very bad dream..."

"Mainly though...Heidi Vodka,our receptionist...saw you buy a can of Fanta Orange from the vending machine and take it into the toilet and come out 1 minute later...you could at least have had the gumption to buy a Diet drink!!"

Oh...okay...well...I just don't have time to wait...

"Ja...well...you don't appear to have UTI either..."

So whats wrong with me ?

"Well...I don't know what your problem is to be honest... but I'll bet it's hard to pronounce...and its only found in the Big Book of Psychiatry..."

Cut here...stitch there

Five surgeons from big cities are discussing who makes the best patients to operate on.

The first surgeon, from Durban , says, "I like to see accountants on my operating table because when you open them up, everything inside is numbered."

The second, from Johannesburg , responds, "Yeah, but you should try electricians! Everything inside them is colour coded."

The third surgeon, from Bloemfontein, says, "No, I really think librarians are the best... everything inside them is in alphabetical order."

The fourth surgeon, from Pretoria chimes in: "You know, I like construction workers...those guys always understand when you have a few parts left over."

But the fifth surgeon, from Cape Town shut them all up when he observed:
"You're all wrong. Politicians are the easiest to operate on. There's no guts, no heart, no balls, no brains and no spine, and the head and the ass are interchangeable."

From your lips to my ear

Its Sunday evening...its 21H28...and we stop booking patients in at 21H30 in order for us to close at 22H00...the idea being that we have a protected 30-minute window to complete paperwork,check drugs,finalise care,steal KY jelly...okay...in fairness...that's probably just me...but you get the point.

Invariably there is always at least one patient who arrives a minute before we close seeking care generally for a problem they've had for a week or two...or sometimes just all day...and they think it would be a good time to come in that late as the Unit would be empty as we are about to close.

These are the same people who think its a good idea to send money to a prince who is held hostage in Nigeria...to vote Labour...to ask for the morning-after-pill a week later...

"Mr ffoulkes-Ayke ? Mr Arthur ffoulkes-Aycke?"

A well dressed young man with an expensive fashionable haircut,wearing even more expensive and fashionable glasses stands up and walks into my room. holding a blood -stained handkerchief to his mouth.

"Hello Sir...and what can I do for you tonight then?"

Well...what it is...obviously...I was playing football this morning and got headbutted in my lip...

"Football ?"...Julian looked at me...I looked back at him and shrugged...

Indeed his very swollen and bruised lower lip is the same shade of purple as his polo shirt...Julian tells me its called 'mulberry'...who knew?

"Right...so what time did this happen?"

About 9 o'clock this morning...

"Uh huh...and why have you only come in now then ? At 9.30 at night?"

Well...I thought it would get better by itself...

"Uh huh...but...?"

Well...it hasn't stopped bleeding...and its still swelling...and anyway...I'm very busy...I had to work on a marketing project today...and I knew you would be quiet at this time of night and I really didn't want to wait...

"Oh...well...thats nice for you...So its been bleeding all day then...hasn't stopped at all?"

No...its been oozing all day...

*sigh*

The outside of the lip is macerated...and has a stellate-shaped wound...like an over ripe plum that has fallen onto the ground from a great height...
More importantly,its a communicating wound as he also has a large laceration to the inside of his lip...

In itself this is quite a straightforward injury...however...there appears to be a little globule of fat that is sticking out of the wound on the inside of his lip...and when I touch it,it feels fibrous

"Right...well...a couple of things going on there Sir...but mainly...theres a little salivary gland sticking out of the inside of your lip...so I'm going to have a quick word with the on-call maxillo- facial surgeon..."

Oh...why?

"Well...its probable that the salivary gland will need to be cut out of the lip...and there are some minor but irritating consequences to that...specifically a thing called a mucocele...so I just want to check with the MaxFax so that we treat this correctly..."

Now I must say that of all the disciplines I ever need to refer a patient too,the MaxFax team in any hospital I have ever worked,are generally the nicest,politest,most accommodating group to deal with...and the guy on call on Sunday was no exception.

Having discussed the patient with him,he told me that he was quite happy to see and treat the patient himself up at St Vulvas'

Result!!! Buff-and-Turf!!!

"Right Sir...I've spoken to the MaxFax and he's going to have a look at your lip and do a spot of repair work...so I'll print out your notes and he will see you up the road at A&E..."

What?...Do you mean to tell me that I've got to go to A&E? What ? Now...at this time of night?

"Exactly right Sir...this time of night...to get definitive care from a specialist surgeon."

But I came here because I didn't want to wait...I've got an important presentation in the morning...can't you just sew it up or give me a cream or something??

"Well...I suppose that you could try haemorrhoid cream ...that should take away the swelling...or I suppose that you could try some duct tape..."

"But you have a large hole in your lip that has been bleeding for 12 hours and you have a salivary gland sticking out waving at your left nostril...so really...you need to see the Maxfax"

Well...I don't think that's very good service!!

"Well Sir... Don't believe everything you think."

"Mandatory Training"

Every year I have to attend various 'mandatory training' courses...along with everyone else who works in the NHS.Doctors,nurses,cleaners,receptionists...everyone...

Every year I go to overheated lecture rooms,drink dishwasher coffee-that I have to pay for-,and listen to some 'retired expert' tell me how to suck eggs...

Every year I have to do fire training;infection control updates;basic life support;etiquette classes on how to scratch your testicles in a crowded room...etc etc

And its basically just so some passive-aggressive manager can demonstrate lip-service to the unrealistic demands based on imaginary events and patient demands of some faceless bureaucrat in London or Brussels.

Their motto is :"Errors have been made. Others will be blamed"

This year, the local yokels in the city council have mandated that I need to learn how to care for vulnerable adults...and I have just spent the last 4 hours being harangued by some mealy-mouthed and past-her-prime social worker ,with a poor dye job,who assured us that we were potentially letting old people and mentally disabled people die because we didn't care enough about them or for them...

Humm...when I challenged her worldview...as you just know I would...she just trotted out the usual phrases that the marginally educated generally,and social workers specifically...-who have never had an original thought in their life-...hide behind...'integrated ,multi-agency care pathways predicated on end-user satisfaction'...

*sigh*

Heres the deal lady...if I didn't like working with people I wouldn't still be nursing!!

And if I simply practice in as safe and inclusive a manner as I can,treating my patients with respect and showing even marginal interest in their life...the same way I was trained to do so 35 years ago...then my patients will be safe.

More importantly though...what really gets me going is the arrogance...the assumption that the only way of doing anything is the English way...the NHS way...there is an implicit belief that no one else has any different or new or...heaven forbid...a better way of doing things.

Now...I don't have a Nobel Prize in Medicine...but when I worked in Children's Casualty at the Johannesburg Hospital for 4 years we had a very slick and responsive plan to child abuse..."robust" even...and whilst I can't speak for what happens now,I can say that the plan that was put together by a whole raft of people including Alan Rothberg and Pincus Catzel and that it really ...really....worked...and the principles and process is easily transferable.

More than anything else that irritated me on a long and arse-numbingly boring afternoon,was her parting shot...delivered in that simpering and yet supercilious tone that Poms of a certain age and class use when talking to their Colonial counterparts...

Well...just do the best that you can.

(Do the best that I can ?)

If I wanted to do the 'best that I could' I'd be a traffic cop...or working for the Labour Party...or picking fruit ...

"Honestly madam...it sounds like English, but I can't understand a word you're saying"

"You are however validating my inherent mistrust of strangers "

This had to hurt!!

This young biker was doing some Moto-X trials and had an accident which included performing six complete somersaults.

He wasn't sure at what stage of the accident that he had sustained his injury.

He had an isolated 'Left' wrist injury;fortunately his non-dominant hand.

Unfortunately he suffered what we call an 'OMG' injury and required immediate surgery as he essentially dislocated his wrist and broke most of the bones including breaking his scaphoid into three pieces.

For reasons best known to himself he decided to drive past the main academic hospital-where he had gone with a previous injury but had what he described as a "bad experience"-,and to come to our Minor Injuries Unit!

He was very excited when I asked him if I could blog images of his x-rays !

Fame is fleeting!!