The Boerewors Emergency Medicine Chronicles

...in which I apparently stumble across the cure for the common cold...

2012-01-23T23:18:00.006Z

Quickly swallowing a mouthful of cold coffee, I glanced at the computer screen to see what ShufflingBob had decided was wrong with the next patient to be seen...his triage notes are often the highlight of an otherwise depressing day.

He had written :- Doing karate,Patient accidentally kicked a wall = swelling + bruising + deformity R great toe.

I opened the door and stuck my head into the waiting room...

"Mr Sulin ? Mr Ian Sulin?"

An expensively dressed, well scrubbed,pink cheeked and cheerful young man waved and stood up and slowly...limpimg...folllowed me into the Unit.

"Would you like a wheelchair Sir?"

No....I'm good thanks...

"You sure...its quite far to my room...about 500m...and there's a little bridge...a water feature...the gnomes can be quite vicious this time of year..."

No....I'm okay to limp if you don't mind waiting?

"Wellllllllll...they pay me by the patient, not by the hour..."

Finally he sat down breathing a sigh of relief.

"So...my name is Lucien....what can I do for you today?"

Well...its my toe...but can I just say how nice it is to see you again...

(Huh...? I'm sure Bob didn't think the patient was confused or mad)

"Jahhhhh....?"

Yes....you saw me about three years ago when I had the flu...

"Jahhhhh....?"

I was really sick and my sugars were all over the place...I'm diabetic remember...?

"Jahhhhh....?"

And when I told you that I was commuting to London every day, for about an hour on the train both ways,-to my job as a banker-,you suggested that I move to London to avoid having people cough and spit over me for two hours a day,five days a week...!

"Jahhhhh....?"

Well....I took your advice...I bought a flat...and I stay in London all week and just come home at the weekend...

"Jahhhhh....?"

Well...I haven't so much as had a cold in the last three years...never mind the flu...and even my sugars have settled down....

"Jahhhhh....?"

I'm so much better...thank you

(Good grief!)

"Well...I'm glad that all worked out for you...whilst we're on the subject of health, can I interest you in subscribing to my weekly TopHealthTips email?"

How much is it...?

"£50 a month..."

Sure...I'd be glad to subscribe...

Note to self...Immediately start a TopHealthTips email.

So there you are....the cure for the common cold..."move to London".

Or maybe its..."don't travel on trains with poor people."

Hummh...actually...maybe its ..."don't live in Crapton-on-Sea."

Maybe its simply..."avoid poor people."

Darn...back to the research lab then...pity as I could really have done with the $1 million Nobel Prize money.

His toe wasn't broken.

A little weary and slightly sad

2012-01-22T19:33:00.005Z

Some days just empty out my reserves of optimism and happiness and fortitude...

...the type of day that stretches my 'cope-ability' to its almost-breaking point...

...when I feel that my heart will finally break ,my mind will finally fracture,my soul will finally wither,pushed over the edge not by any big crisis of love and death that comes to us all,but by the thousand cuts of everyday anguish...

...and which leaves me wondering about the futility of what we do in emergency/primary medicine...and how we can ever really help our patients have a 'good' or (statistically) 'normal' quality of life in spite of themselves and the evil hand that fate or G-d or happenstance...or maybe just plain old unadulterated genetics...has dealt them.

YummyMummyNurse was working a shift today,back from maternity leave.

She is smart and clever and well educated in the strange English way that is based on lots and lots of book learning and tutorials and empowerment seminars and human-rights-driven protocols and "group problem solving dialogues" , but has little to do with ever actually seeing or working with any actual people with real and complex health issues.

Her office is unfortunately next to mine.

Can you help me with this child I'm seeing ? she asked.

"Sure...whats happening?"

Well...her dad says she has 'MF1' disease...and I haven't heard of it before...have you?

...she asked,in that tone of voice that suggests that she doesn't really expect me to know more than her...since I trained in the Jungle...

"Ummh...nope...can't say that I have..."

Well...her dad brought her in because her face is all swollen...and I think it is but I'm not sure...

"Okay....well...lets go and look at the child and talk to the dad "

Now there was a rule of thumb in paediatrics when I was training,(in the days before accessible DNA testing), that suggested the following:-

'Normal Looking Parents' will probably have 'Normal Looking Children'

'Funny Looking Parents' will probably have 'Funny Looking Children'

But that if you ever saw 'Normal Looking Parents' who have 'Funny Looking Children',then you should have a high index of suspicion for some sort of congenital health/medical problem that may hither too have been missed...or which the parents know about but might not tell you about during the course of a brief ER type consultation, due to embarrassment or disinterest.

Yes...disinterest.

We went into my colleagues room.

The father was sitting holding his four year old daughter on his lap...she was 'well presented' as were her 2 brothers...but she undoubtedly,unfortunately,looked a little odd and all sorts of alarm bells went off in my head.

My heart sank.

"Hello gorgeous..." I smiled at her..."So...my name is Lucien...whats going on then dad?"

Well...we're here on holiday...and I think her face is swollen...and she has this illness called MF1 and I'm just worried about her...

"Okay....lets have a look at you then Miss...."

She quite happily let me pick her up and examine her.

"Okay then...there we go..." I gave her back to her dad.

"Are you sure the illness she has is called 'MF1' and not 'NF1"...?"

I dont know mate....I think its "M"....but I might be wrong...

"Jah....I think she has a syndrome called 'NF1'...or neurofibromatosis type 1"

Okay then mate...you probably know better than me.

Its just so sad.

He clearly loves her...she clearly loves him...he was clearly worried enough about her to bring her in to see someone...but he doesn't even know what her illness is called.

Fortunately the on-call paediatrician knew all about it...and since we were unable to distinguish between her usual/disease mediated physiognomy and the swelling that was worrying her father...agreed to see her.

They had no car.

They were going to catch a bus to the hospital as he didn't have enough money to pay for a taxi and she didn't warrant an ambulance.

We paid for the taxi.

Fortunately I had some emergency chocolate in the boot of my car.

It didn't stop me worrying about the child...and of reminding me of all the children with rare illnesses I have seen...

...fortunately I have even more emergency chocolate in my bedside cabinet.

Take the first right,stop at the lights,swerve around the umbilicus..

2012-01-16T19:18:00.008Z

“Good afternoon…what can I do for you today?”

Well…what it is…obviously….I had a Cesarean 11 days ago…and I think the operation (sic) is infected…

“Okay…how’s your baby doing?”

Fine I suppose…

“Okay…do you have any underlying medical or surgical problems of any sort?”

No…

“Do you have any health conditions or problems I need to know about?”

No…

“Okay…so do you take any medicines of any sort-, on a daily basis-,for any reason-,medical or otherwise?”

Well…just the fluoxetine for my depression

“Is this post natal depression…since the birth of your baby?”

No….I’ve been depressed for years…

“Okay…are you breast feeding?”

No…it hurt too much last time

“Okay…ummhh…right…do you smoke?”

Yes!

“Are you married or do you live with someone?”

No…

“Okay then…lets have a look at your C-section scar then…please just lie down on the couch there...”

She got up from the chair to lie down on the examination couch as I went to the sink to wash my hands.

“So…where did you have the surgery then?”

She look at me like I was stupid...

On my tummy…?!?!

"I meant....which hospital...?"

I looked at her like she was stupid.

Only one of us was correct.

I didn't really mind that...

2012-01-14T22:35:00.004Z

Dear Madam

I didn't really mind that you came to a busy Minor Injuries Unit on a Saturday afternoon with a condition you described as "passing fresh blood from my back passage"...

I didn't believe you when you said that you had never had hemorrhoids...(or piles)...before,but I didn't really mind that I had to examine you...

I didn't really mind that your husband-,who is 25 years older than you-, sat in the consulting room the whole time...

I didn't really mind that your husband seemed to enjoy watching me perform what is quite an embarrassing examination on you...

I didn't really mind that your husband is a Registered Sex Offender and that was why I had to examine you as the Designated Nurse for Perverts in this area...

I didn't really mind that you had clearly not cleaned your "back passage" after your last bowel movement,despite knowing that you were coming to hospital...

...that is after all why I was wearing a mask...

I didn't really mind that I had to prescribe some medicines for you and that you will not pay any prescription charges because neither you nor your husband work because you are both on 'benefits' due to "stress" ...

But honestly...

...when I suggested that you go home and have a shower and clean yourself up before using the ointment...

...was it really necessary to turn to your husband...

...and in a simpering "little girl lost voice" ask him to wash you 'down there'...

...and then for him to smile tenderly back at you and agree to do so...

This job...

...this town...

...sometimes its like a government experiment in scum propagation...

...and my Unit is the petri dish...

*Oy*

Not a 'New Years resolution' as such...

2012-01-13T17:41:00.011Z

...more the result of a quiet time of reflection and introspection sparked by an impending birthday...

I had a scheduled 'day off' today.

I worked last weekend...'Long Day' shifts on Saturday and Sunday,from 0745 to 2200;had some planned intensive study days on Monday/Tuesday/Wednesday at the local University Library as I am writing the nurse-prescriber exam on 29 February and only opened the course-workbook last week...

....dear Lord....there is soooooooooooooooooooooo much I need to read;worked a Long day shift yesterday;and I am working again all weekend.

So today was a day of rest.

A day to relax a bit;do a deep food-shop and think about my life in view of the upcoming birthday.

I am not someone who believes that external dates or events accurately reflect our passage though life or in fact in any way really benefit us individually...if you know how to use a calender....if you understand the concepts of a monthly salary cheque...of a yearly tax bill...and of the four seasons...(no...not the hotel...no...not Vivaldi...pay attention!) then really that's all you need to know to mark external time-,business-time-,family-time-,society time if you will-, and allow you to timeously buy Easter eggs. or go to your granny for Yom Kippur or your cousin for Ramadan.

I believe that the life altering events...the dates we look back as being pivotal in our individual and collective lives...are almost exclusively external and beyond the control of most of us for most of the time.

This year for example will mark the anniversary of the sinking of the Titanic and there are already any number of events planned.

Why? Was it really because it marked the end of the Edwardian Age in England and presaged a more eligatarian time which was to follow the First World War?

People in my current part of the UK still go on and on and on about 'The Thatcher Years" and how she ruined their life.

South African politicians still talk about the 'Apartheid Era'.To be honest,it still defines so much of my life and my relationship with my surviving family and friends.

I think that the dates we should use-,the dates which in fact end up marking the high tide and low tide moments of our life fall into four broad categories.

Firstly,there are those (many , many) times which are basically beyond our control such as when we are born...when someone we love dies...when we fall in love or get divorced.

These can be "personal" such as the birth of a child;"physical/environmental" such as a drought or tsunami;"ideological" like the Arab Spring;or "structural",like a recession.

Secondly,there are the (several) times when things happen to us that fundamentally alter our life and over which we have appear to have had no control but which might have been possible to predict;events though which allow us to change our behaviours and use the sequelae of the event to our advantage in an altered future ...an extreme example is having a heart attack which has been brought about by poor lifestyle choices...and which results in the person choosing to stop smoking and start exercising , resulting in a better quantity and quality of life.

There is a corollary to this of course when the events were more difficult to predict and over which we possibly had little control-,(such as being knocked over by a bus when sober in daytime)-,and where the consequences are as life changing but not necessarily for the better.

Thirdly ,there are the (few) times in life when the irresistible force of cognitive dissonance hurtles juggernaut fashion towards the immovable object of physical/financial/emotional reality and finally you understand that life-altering,paradigm-shifting and potentially emotionally (occasionally even physically) painful change needs to happen...when you finally internalise the concept that 'if you always do what you always did,then you will always get what you always got' .

You will change your behaviour irrevocably...you seek a divorce,leave a well paid job to work for yourself, you emigrate.

Finally there are the days when seemingly out of the blue,you will have a flash of insight into your life and how you are living it, which forces you to unexpectedly reassess your life when you weren't particularly planning or wishing to do so.

As a Freudian,I don't really believe that these moments are ever really random....they just appear in our conscious mind when our unconscious mind knows that we are primped and ripe for change,such as just before our birthday.

Sometimes it dictates immediate and manifest change...sometimes you just open a KitKat.

I had a 'fourth type' moment today.

It was a beautiful day , weather wise, here where I live.

I should probably put that in context for foreign readers.

What that means in England is this...for some part of the day...some part of the sun was visible...for some time....in a sky which was blue,for some time.

And that this morning,due to a 'perfect' alignment of the space/time continuum,the temperature was moderate,there was no wind and I had money in my wallet.

And so I set out to do some shopping.

I am a food snob.

I like meat to taste vaguely like the animal whose picture is on the package.

I remember at the Johannesburg General Hospital residence that meat was served in one of three categories....'Friday-night-alleged-steak'...."mostly-minced",in spaghetti bolognese...or "flat"...thickish slices of grey or pink or brown meat whose only discernible feature was that it was 'flat'.

And I have found that the quality of food available in supermarkets here...outside of London...is quite poor...so I tend to shop at Marks and Sparks where the ready meals are fairly priced,calorie counted, and generally edible in the middle of a 14 hour shift.

Also....their fruit and veg is of a good standard.

Also...there are no poor people shopping there,hauling their 27 snot-nosed kids around behind them,pawing at cut price packs of camel hump in chilli sauce.

Although it does get more than its fair share of old people who also wander around in a daze...but at least they don't try and mug you in the car park.

Anyway...I had done my shopping and was walking past a display of various bits of lounge furniture on the way out of the shop when I had a sudden bizarre thought...

...a moment of clarity into my life and how I have been choosing to live it...

....I am 55...

...I have never owned a sofa that I have chosen...

...I have never owned a reading chair that I chose...

...I have never slept on a mattress of my choosing...

...in fact....I have never owned any furniture that was of my choice...

...there are many items of furniture I have paid for...but none I chose...

....(with the single glaring exception of the chair on which I now sit and which I bought only 2 weeks ago)...

...growing up, my parents bought all the furniture,as you would expect...

....then I stayed in the nurses residence for years, as both a student-nurse and registered nurse,and which was furnished by the government...

...then I moved into a flat with my (future) wife and 'we' furnished it...

...now men know that this means you buy exactly what she wants after putting up a token show of interest and enthusiasm...

...now I liked that first sofa...its was a two-seater,Laure Ashley-inspired floral print job,but not deep enough for my fat bum,or indeed even long enough to sleep on...

...and this pattern continued throughout the years of marriage.

When she left (and took most of the furniture) I stayed in the house with the (by now) decrepit furniture.

And since living in the UK,I have stayed in a variety of furnished bed-sits, furnished shared houses;and finally in my current furnished and serviced apartment...which doesn't have a sofa at all.

All those years without a sofa.

All those sofa sales every easter.

And that prompted a stream of depressing consciousness if I am honest.

It then occurred to me that my birthday will mark another year in which I have remained celibate and unattractive to apparently any sentient female of any age anywhere in Europe.

Its odd because as an adult I have been single for longer than I was married plus in various odd relationships...and I am the constant factor in the equation...which makes me think...

Its not through lack of trying...I've dated The Troglodyte;The Racist;TheMoleWithThe WomanAttached;The Stalker;The DesperateTeacher;The Nympho...okay....I dated her several times until my cardiologist told me to stop...The FranklyDisturbedWoman;The MBGITW;and several assorted woman....oh...lets not forget the OneWhoPulledTheKnife.

Another year bereft of any actual loving touch...

...indeed the only physical touch of any sort in the past 2 years has been that of my very-butch,very-lesbian,very gorgeous,very funny chiropractor.

Mind you,I stand very very straight.

Also...there was that hug from the chimpanzee I've sponsored at the London Zoo.

She may be a monkey but at least she's female...

...and another mammal.

So....my fourth-type day.

Today.

The day on which I have decided to seek a more abundant life.

I can either change my life...

...or just join the church as a monk so at least I'm earning credit in heaven...

I'll make a decision just as soon as I've finished the packet of pork scratchings...

....ummhh...maybe I should just sponsor another chimpanzee?

Romeo + Juliet

2012-01-06T19:27:00.005Z

The first rule of emergency medicine is this...all patients fabricate (at least) and pointblank lie (at worst) about part-, or all-, of the reasons and events which have resulted in their needing medical help.

Period.

ALL patients lie.

And that's okay really...we know that...we factor it into the consultation...its why we ask the same questions in different form...and keep asking them...and frankly,we'll lie right back to you..."no of course this isn't going to hurt you!"

The difficulty with 'head injury' patients is this though...what is their "normal level of stupidity" and what may be caused by an actual brain injury?

And what percentage of their inability to name the Prime Minister is due to indifference and what part is due to alcohol and/or drugs?

The patient was a 24 year old fisherman who had allegedly been assaulted in some local hostelry by some complete strangers whilst waiting to start a Bible study class.

He was completely oriented to the "time/place/person/prime minister/monarch" questions;his cranial nerves were all grossly intact;his pupils were 'equal,reactive and accommodating'...but he couldn't tell me the name of the pub he had been in when he was allegedly assaulted...well...I knew then he was lying.

Result.

If you're smart enough not to want your girlfriend to know where you were when you were assaulted , then your excuse-for-a-brain is probably working just fine.

He was a lanky young man with a stack of gelled hair , sticky-out ears ,and a chipped front tooth...apparently from another bar fight.

He was dressed in the ubiquitous tracksuit...and smelt of dried sweat,working sweat,stale sweat,sleeping sweat,old sweat,sexual sweat,Christmas sweat,New Year sweat..even Halloween sweat.

(I had to put on a mask to examine him he smelt so bad...I told him it was because I had a cold...)

(You see...we do lie!)

He was accompanied by his girlfriend...a pretty if grubby young woman dressed in electric blue jeans,-about 2 sizes too small-,and a grey woollen top covered with what looked like glitter.

She was clearly worried about him and was sitting holding his hand (with her right hand) and texting with her left hand.

Apart from various bumps and bruises, (and with no real concern for a brain injury),his main injuries were 2 lacerations that needed to be sutured:-the first was a 1,5 cm long laceration to the top of his head...it was deep and bleeding profusely.

The second cut was 'T-shaped' with the top of the 'T' just below his hairline and the vertical arm,-about 2cm long-,extending down his forehead towards the middle of his left eyebrow.

"Right Sir...I'm going to stitch the top of your head first, to stop the bleeding and to get it out of the way..."

"I'll pop in about 3 deep sutures which should stop the bleeding...it'll take about 3 minutes..."

Okay mate...

His girlfriend looked anxious...Will it hurt?

"Well...the local anaesthetic can sting a little bit...but it could be worse..."

How could it be worse...?

"Well...it could be my head needing the stitches..."

He laughed.

She looked anxious.

"And then I'll have a look at your facial laceration...that's going to take about 10 minutes...I want to get a good cosmetic effect on your forehead..."

What do you mean...'cosmetic effect'...?

"Well...the laceration is deep and is going to be visible...and I don't want you to have a scar like Harry Potter...so its going to take some careful apposition of the wound edges..and some small fine sutures...."

Don't bother mate...just stitch me up...

His girlfriend winced....Please take your time...

"Of course I will..."

No really mate...just stitch me up...why do you have to worry about the cosmetic thingy...?

"Well....I only know one way to suture a face...'mate'...and that's the Johannesburg Hospital way...the correct way...so if it's all the same with you,that's what I'll do..."

Okay then...well if you fancy you're a plastic surgeon,what about doing something to my nose...?

OY!

"No time tonight..."

Well then...

and he pointed at his girlfriend...

...have you got time to do something about her tits?

He laughed.

I winced.

She cried.

True love.

Its a wonderful thing.

I gave her my phone number...listen...I may be older, but I'd be very grateful.

The first patient of 2012...

2012-01-01T22:49:00.005Z

The first patient was a 4 year old boy,-Timmy-, who had been tugging at his ear overnight and was a little quieter than normal according to his father.

He was "well presented",was playing happily in the waiting room ;and had been given sufficient analgesia.

I examined him and determined that he had an inner ear infection,an otitis media,and decided to prescribe some Amoxil syrup for him.

We have a small dispensary in our Unit for 'out of hours' medicines when patients are unable to get to a pharmacy.So I asked Timmy and his father to wait in my room and went to make up the antibiotic.

I returned shaking the bottle of day-glo yellow syrup .

"Right...here's Timmy's medicine...keep it in the fridge...shake it before use...he needs to finish the whole bottle...come back if you have any further concerns...Okay?"

Timmy looked at his dad...

...is that for me ?

Yes...its all yours, smiled his father.

Its a nice colour...does it taste nice...?

He looked at me.

"Yes...it tastes of bananas..."

Will it make me all better...?

"Yes it will..."

He smiled.

Thank you!

What else do you say...?

Oh...ummhh...happy new year!

Sometimes...just like you couldn't make up the crazy stuff...you also couldn't make up the nice stuff.

The final patient of the year...

2011-12-31T22:29:00.004Z

You're the best doctor I've ever seen....no really....you really care about me...

I wish all my doctors were as good as you....

You're a real star mate...

Well of course he was drunk.

In fact 'drunk' is too subtle a word to describe his state of inebriation.

He had been walking home with his girlfriend,-also drunk-,(although they both assured me that she only drinks on her birthday and on New Years Eve),when she had made the not totally unreasonable request that he choose between her and his drunken smack head cousin who had not only been released from Prison this week,but was sporting a Mochician haircut that was dirty and 20 years out of date.

Naturally he had chosen his cousin on the grounds that "blood is ficker than water...innit??"

When they got home she threatened to end the relationship (which has already survived 2 years apparently) and so he had punched a wire mesh window in the bathroom...

...and then went outside...

...and punched a brick wall...

...and then came back inside...

...where she remonstrated with him...

...and so he punched the kitchen table.

I x-rayed his wrist which looked broken (but wasn't) and his hand which didn't look broken (but was)...got the HCSW to clean his wounds and strap him up and discharged him.

You're so wonderful...really mate....I've never met anyone like you...

Can I see you all the time...?

Its funny really...because I saw him on October 22 this year,with a raft of similar injuries...in fact I could have just cut and pasted his notes from his last visit...as if I ever did anything like that!!

He has visited our Unit 10 times in the past 6 months,all for hand injuries...

...and when I last saw him I documented that he was rude and unco-operative and rude and abusive and rude and drunk and that in fact used the "A" word to me...

...that's correct...

...he called me an Australian!!

But he was so happy and it was so close to home time that I didn't want to remind him of our last encounter.

In fact he was so happy that he believed me when I told him it was National Prostate Awareness Day and that I needed to perform a digital rectal examination on him!!

Okay....I made up the bit about the DRE...I would rather eat a cream scone from the hairy purple arse of a baboon in the front window of Harrods!

And so to bed.

Another year done.

Night night!!

...ps...perhaps you could do a vasectomy whilst he's asleep...

2011-12-30T19:40:00.005Z

To : The Hon. Plastic Surgeon on call

Thank you for accepting this patient.

I have also spoken to the on-call Urologist who has agreed to see the patient when he is admitted.

This gentleman reports that he discovered a "spot/lump/red swelling" on his penis,just adjacent to his foreskin about six weeks ago;and that he assumed that it was a wart.

As he is a long term unemployed scrounger on benefits,trying to gain a place in the England Drinking Team for the 2012 Olympics, he reports that he didn't have any time to see his GP or to attend our Unit prior to today.

He did however go to a pharmacy where he was sold an OTC wart treatment gel;and he has applied this gel twice a day,for four weeks.

His treatment plan has successfully eradicated the original "wart".

Unfortunately,he has presented today with what can best be described as a septic burn to his penis.The diameter of the crater is 2cm with a depth of about 5-6mm;I am concerned that he has burnt completely through the skin and down to the erectile tissue.

He has been able to pass urine and also to achieve and maintain his erections over the past few weeks but is now experiencing pain to both of those activities although it hasn't diminished his desire to have sex with every available drunk woman in the Northern Hemisphere.

Kind regards

Lucien

PS Happy New Year

'Fairytale of New York'...as you've never heard it

2011-12-27T13:32:00.003Z

Finally a day off after a busy 3 day christmas stint at work.

Merry Christmas.

Happy Holidays.

Whatever.

Enjoy!!

And for those who want to do a little karakoe...heres the lyrics...

Pogues Fairytale Of New York Lyrics

It was Christmas Eve babe
In the drunk tank
An old man said to me, won't see another one
And then he sang a song
The Rare Old Mountain Dew
I turned my face away
And dreamed about you

Got on a lucky one
Came in eighteen to one
I've got a feeling
This year's for me and you
So happy Christmas
I love you baby
I can see a better time
When all our dreams come true

They've got cars big as bars
They've got rivers of gold
But the wind goes right through you
It's no place for the old
When you first took my hand
On a cold Christmas Eve
You promised me
Broadway was waiting for me

You were handsome
You were pretty
Queen of New York City
When the band finished playing
They howled out for more
Sinatra was swinging,
All the drunks they were singing
We kissed on a corner
Then danced through the night

The boys of the NYPD choir
Were singing "Galway Bay"
And the bells were ringing out
For Christmas day

You're a bum
You're a punk
You're an old slut on junk
Lying there almost dead on a drip in that bed
You scumbag, you maggot
You cheap lousy faggot
Happy Christmas your arse
I pray God it's our last

I could have been someone
Well so could anyone
You took my dreams from me
When I first found you
I kept them with me babe
I put them with my own
Can't make it all alone
I've built my dreams around you

copyright 1988 Shane MacGowan & Jem Fine
Songwriters: JEREMY FINER, SHANE MACGOWAN

Suffer the little children...

2011-12-25T19:24:00.013Z

Christmas Eve...and on a Saturday...so combined with the usual end-of-month/payday/Friday-night-party "PFO injuries"...exacerbated by the post-'end-of-year-free-alcohol-staff-party' requests for Emergency Contraception and the removal of various foreign bodies from various body compartments...all topped off with the confused,dehydrated and lonely and afraid "lets-see-whats-happening-to-granny" patients.

Still and all,we were doing well...there was a two hour wait which didn't seem too excessive...after all...my shopping was already done...

And so the day droned on with only the occasional mince pie to remind us that it was anything other than a typical Saturday.

Five o'clock...an hour from my evening meal break...the chili prawn linguine was already calling me...

...and the next patient to be seen was a baby with a sore arm...who was apparently only six months old.

"Baby Cabbage Patch?"

I didn't really need to ask who he was...there were two babies in the waiting room,but only one was screaming in pain.

A scared looking young woman stood up clutching the baby...a bag...a blanket...her handbag...and a cellphone.

A young man,long shaggy hair,long shaggy jeans shambled in behind her,looking upset.

"Please come through to my room..."

She followed me holding the baby out in front of her,arms rigidly straight,like he was a live grenade.

"Whats happening then?"

Well...what it was...we was at home...and he tried to stand up...and he fell and hurt his arm...and he hasn't stopped screaming...and he's not using his arm...

"Did he fall backwards...or forwards...or sideways?"

I don't remember...

"Okay...have you given him anything for the pain then?"

No...we just brought him straight here...

"Okay then...lets get him undressed...completely undressed down to his nappy so that we can see whats going on..."

She dropped him onto the examination bed , grabbed his possibly-injured right arm and started to tug his babygro off of his injured arm.

"Stop...stop...lets take his good arm out of the babygro first...then slip it over his head..and then take his bad arm out..."

Okay...

"Are you his mum and dad then?"

No...I'm his aunt...this is my brother...my dad brought me here cos we was at their house...

"Okay...where is his mum or dad then?"

Ummhh...well...they've just been arrested by the police...

"Okaaaaaaaaaaaaaaaay...was he with them when they were arrested?"

No...I was babysitting for them cos they wanted to do some shopping...

"Do you know why they were arrested?"

No......my dad might know......he's sitting in his car with my daughter...

"Okay then..."

She was struggling to undress the boy who was still screaming.

"Look....just stop okay...let me undress him..."

I noticed the old dried faeces on the bottom of his vest...and made a mental note.

I examined him fully...and couldn't really find any indication of an injury,new or old...no swelling or bruising or redness or deformity or wounds.

No burns

But every time I picked up-, or moved-, or tested his right arm,-from his fingers to his shoulder-,he screamed.

Is he going to be alright mate ? asked the uncle

"I think so...lets just get some x-rays done...I think we're going to x ray his entire right arm...will you sign the consent?"

Ummh...no...I'd rather not...said the aunt

I'm only 17, said the uncle.

I signed the paperwork myself and,-having weighed him and given him "Gods-own" dose of paracetamol-,whisked him off to the radiology department where the ever efficient Anna very quickly did a series of films for me...all of which turned out to show absolutely no obvious bony injury of any sort.

But still the baby was screaming.

I had taken the opportunity to talk to the grandfather about what he thought had happened...I found him sitting in his car with his 4 year old granddaughter,engine running,music blaring,heater blasting.

I knocked on the car window and asked him to get out of the car.

He too seemed unsure of how the baby boy had fallen...and could not...or would not tell me why his daughter and "son in law" had been arrested.

I couldn't help noticing that he only had one arm.

I also took the opportunity to phone the duty social work team to see if the child was on the child protection register.

After the usual runaround of wanting to know exactly,precisely,definitively why I wanted to know,they deigned to inform me that the family where "known to the family support team"...

...and that there were "behavioural issues" with the parents in regard to their dealings with the Housing Department inasmuch as they were holding out for a 3-bedroomed house against the flat they had been offered...

...and...oh,by the way...the father had done prison time for domestic abuse...

...but...

...all things considered...the child was not deemed to be at risk and was therefore not on the register.

*sigh*

They came back from radiology,with the uncle looking shell shocked and the aunt looking scared.

I wrapped the little 'baba' in a blanket and held him tight and rocked him and sang a little lullaby as I considered my next move...

...which was to phone the on-call paediatrician and throw myself on her mercy and beg for clemency.

I explained the family and social and medical situation and raised my concerns...she very kindly agreed to admit him to the Children's Assessment Unit at the main hospital.

I decided to transfer him to the hospital in an emergency ambulance (a) because he was still screaming inconsolably (b) I was concerned the family would try and do a runner (c) I don't trust either the cops or the social workers to actually provide any meaningful help(d) but I do trust the paramedics.

The 'baba' was still crying...I was still holding him tight.

Listen mate...said the uncle...can I go to hospital with him?

"Sure..."

Can you give me a note for the control room?Its just that I've got an ankle tag on and my curfew is at 7 o'clock...

(He was on probation and was fitted with an electronic ankle tag which sends an alarm to the probation team if he's not indoors from 7pm to 7am)

"Jah...sure....I'll write a note"

An ambulance finally pulled up 20 minutes later...

...but it was a delivery...

....of a chap who had been in a local chain restaurant toasting his daughter at her wedding reception...

...when he heard a noise above him and looked up at the ceiling...

...as it gave way due to the pressure of a burst sewerage pipe...

...which decanted its load into his eyes...

*sigh*

Finally our ambulance arrived...about two minutes after the baby's mother...who refused to answer my questions...

...and the baby was whisked away to the loving care of the peads department.

That baby really could scream.

All I managed to eat was a yoghurt.

It was the sort of day that puts the "freak" back into Christmas.

Merry Christmas you suckers....you miserable men

2011-12-25T07:22:00.003Z

I first heard this song on the car radio about 15 years ago...the children and I were in Portsmouth for a Christmas break...we all laughed out loud ...

You can listen to it here

Enjoy!!

MERRY CHRISTMAS, YOU SUCKERS
(Paddy Roberts)

Merry Christmas, you suckers, you miserable men.
That old festive season is with you again.
You'll be spending your money on cartloads of junk
And from here 'till New Year you'll be drunk as a skunk.

Merry Christmas, you suckers. It's perfectly clear
That you fall for it all a bit sooner each year.
If it goes on like this, you will find pretty soon
You're singing "White Christmas" as early as June.

This Christmas card racket
Will cost you a packet.
Each season, it seems to expand.
The cards are so clever,
Though nothing whatever
To do with the subject in hand.

You'll be taking the kids 'round the multiple stores
To be frightened to death by some old Santa Claus.
Then it's parties with spirits and "vino" and beer.
Merry Christmas, you suckers, and a Happy New Year!

Merry Christmas, you suckers, you bleary-eyed lot.
You'll never get rid of that headache you've got.
But I hope you'll feel splendid. you certainly should,
With your stomachs distended with turkey and "pud."

Merry Christmas, you suckers. Jump into your cars,
Roar off to your neighbors to "sink a few jars."
Though your vision is double, just keep smiling through.
There are others in trouble a lot worse than you.

Beyond any question,
Acute indigestion
Will plague you and make you unwell.
You won't take the warning.
You'll wake up each morning
Undoubtedly feeling like hell.

But, stick to it, suckers. Go swallow a pill,
For this is the season of peace and good will
While we patiently wait for that nuclear blast.
Merry Christmas, you suckers. It may be your last.

And off to work I go...!!

take 2 aspirin and phone your girlfriend in the morning

2011-12-24T07:02:00.003Z

He couldn't explain what he meant by "dairy"...

Jah...I also sometimes get a headache after sex...when I get the bill!!

On alzheimer's

2011-12-23T16:33:00.006Z

I know that its almost Christmas...

...and that this is essentially a humorous blog...

...but I was sitting at work yesterday reading my (beloved) "Times" ( and eating a sticky bun) when I read an article by AA Gill about his father and Alzheimer's which made me weep...

...thinking of my mother...

...thinking of the many older folks I daily see as patients...

...desperately trying to pretend that they can care for themselves,wearing their cleanest dirty clothes...

...malhourished...

...unfocused eyes looking for some distant,golden past which they understood...

...pretending that they can understand what I am saying to them...

...people who live partial lives,in the shadows of society,abandoned by their supposedly 'near and dear'...

...unaware really of who they are...

...of what they may have achieved in their life...as a citizen...a mother or father...a brother...daughter...friend...

...unaware of what is happening to them...

...people I am afraid to discharge "home" with their broken wrist...

...whom the hospitals are unable to admit due to the sheer volume of patients...

...whom social services have abandoned due to the cost and the aggravation and because they prefer to focus on 'the youth'

...concerned that a broken wrist or sprained ankle...that even a simple chest infection...might in fact be a death sentence for them.

The CDC says this about Alzheimers.

And the NHS says this about dementia generally.

I make no apologies for "reprinting" this article...I bought the paper yesterday and I subscribe to the website...

*sigh*

...I think it is beautifully written and provides a real window into the difficulty of loving someone who has this disease.

The thing with this sentence, this arrest of dementia, is that its greatest victims aren’t those who have it. That’s not to say that the diagnosis isn’t dreadful for the recipient, but there is a peculiar and particular hammering sadness for those that love and care for an Alzheimer’s spouse or parent.

It is a wearying and lonely obligation, but with the added cruelty that the person you’re looking after vanishes, escapes before your eyes. In the end, you’re caring for the case that someone came in.

The job of keeping them alive and comfortable becomes a monumental act of memory, which is, among all the other sad ironies of age, a particularly poignant one. As the patient forgets, so the carer has to remember for both of them. There is nothing good or positive to be said about Alzheimer’s disease, no redeeming or consoling posy to be plucked from its miserable wreath.

I remember — how many sentences about Alzheimer’s begin “I remember”? — I remember when my father had the illness diagnosed. Our family’s sad shock, the retrospective detective-work and the realisation — or admission — that we’d sort of known for some time.

But there was his own sanguine and often funny acceptance of his lot. He was a man who’d lived almost entirely in his own head, in the cerebral, always surrounded by books, walled in by the tomes of his broadly intellectual life. When reading and writing became impossible, he stared at the page and said with a resigned wonder that the words ran like ants in the snow. Then he would sit and watch the autumn sunlight fall across the room.

Since his death, I’ve seen a number of Alzheimer’s patients in their homes and in care, and I’ve grown to recognise that look; the quiet regard. They aren’t seeing what we see. They watch some personal reverie, and in it, rise above their sickness, are perhaps untouched by its humiliations and losses. But there is no such place for those who feed, wash, turn and continue to chat with the one-sided monologue of cheery commonplaces. The lists of names and destinations, the harking back to perhaps ignite some last, glowing memory, to connect once more, however briefly, with a shared life.

When he was very close to the end, I took my daughter to see her grandfather in hospital. She was upset, not just by the passing of her granddad but by a closer fear: “I don’t want to see you like that, Dad.”

There was, and is, no guarantee. As we continue to survive other once-fatal conditions, to live longer, so dementia claims more of us. And while we may wish for the kindly, instant death of the calamitous stroke, the speeding aneurism, or the firm embrace of a cardiac arrest, to depart in our sleep or, like my grandfather, watching the nine o’clock news, increasing numbers of us will drift away, one ripped-up photograph at a time.

An Alzheimer’s carer must face a wave of ancient fear. More than the illness itself, we dread its imposition on our family, the guilt, the expense, the damnable pity, the waste of other, active lives that should have better, more productive things to achieve, the leeching of fun and laughter. And we fear above all its imposition on our memory, the further irony that this is, after all, how we will be remembered.

In particular, over the years of my dad’s illness, I had the constant worry that my abiding image of him would be with Alzheimer’s. The final, penurious cruelty is that it would wipe all the other memories of him away, that I would only think of him as an ancient, rheumy-eyed, gentleman.

But now, as the years pass I still think of him often, and it is in all the ways I knew him: picking me up from school, smoking his pipe, in his skinny safari jackets in the 60s, his shock of white hair in middle age, telling me stuff, showing me things, mostly just sitting in his armchair writing on a clipboard, surrounded by books.

And I also remember the Alzheimer’s, I haven’t been rid of that. But now it’s not with anger or resentment. The illness gave us a long time to make our farewells. There was nothing left unsaid between us, and that is a boon not allowed by the sudden coronary or the number nine bus.

There were no more rows or arguments that had punctuated the earlier part of our lives. The fights of fathers and sons were done. What we did have in the end, to share, was food.

It was ever the leitmotiv of our family. My brother was a chef, I wrote about it, and Daddy loved to eat. When finally he had no idea who I was, when, as Shakespeare has it, he was sans sight, sans teeth, sans everything, I would visit with a tub of chocolate ice cream, his lifetime joy, and we would sit together in silence, eating. That, now, is one of my dearest remembrances. Food is ever the great simile and metaphor, the binding of us, the evocation of the past, the fuel of the future.

As I write this, on my desk is a picture of my Dad and me. Of all the photographs I could have chosen, it is a very late one. He has that pensive, distant look of dementia. We’re sitting in the park, my arm through his. I’m looking off into the distance. He’s inverted into the past, me into the future. It’s a maudlin and precious image.

There is nothing good to say about Alzheimer’s, but there there will never cease to be marvellous things to say and remember of those who suffer it.

A.A. Gill is an ambassador for the Alzheimer’s Society, one of the charities chosen for The Times Christmas Appeal.

...in which I am 1 second away from punching someone on the ear...

2011-12-21T17:41:00.009Z

So up early today to schlep off to another God-forsaken part of this vast Isle of ours,to do some freelance lecturing...which I do from time to time since I found that I had inadvertently emigrated to Povertyland a few years ago when I wasn't paying attention.

So up at silly o'clock this morning and on the first train (at 06H08) for an hour and half...then a 20 minute wait in a draughty station where a cardboard beaker of alleged coffee costs the price of a small house in Africa...and onto a second...smaller...dirtier...smellier commuter service to the decaying town of choice for today.

It goes without saying really that the heaters were not working on either train...and that the public toilets had been locked at both railway stations...fortunately my full bladder did provide some warmth.

So by 0815 ,on the second train, I was alone in the train carriage,dozing fitfully,spread across two seats,legs jerking occasionally as I dreamt of happier places to be,with today's (partially read) copy of the "Times" on the seat next to me.

The train shuddered to a stop at some cold and distant doorway to Hell and I was conscious of some of new passengers getting into my carriage...

...of a young man...

...who looked like Hagrid...

...on dress-down-Friday...

...combined with a bad-hair day...

...followed by two alleged female passengers...

...both also having a 'bad-face day'...

...and as he loped past my set of seats...

...he reached down and grabbed...nay...stole...my newspaper...

...and then continued on down the train followed by two women..

(Now its fair to say that I have very little joy or happiness in my life at the moment...and my daily copy of the Times is the single biggest pleasure I have...)

"HEY!! BUDDY!! What are you doing with my paper?"

He ignored me and continued down the train.

I jumped up and shouted again...

"HEY!! ASSHOLE!!"

He continued to ignore me.

I pushed past the two women and grabbed his shoulder and pulled him around to face me...

...panic stricken he threw his arms up in front of his head...

...his unibrow performed a 'WTF" movement...

"Hey...buddy...what do you mean by just stealing my newspaper from my seat???"

He looked at me blankly.

One of the women pulled on my arm...

He's deaf...he can't hear you...

"Right...okay...but still...why did he steal my paper?"

She 'signed' to him...well...she waved her hands around and then pointed at me and waved her fingers...even I know the international gesture for "wanker".

He says he's sorry...

...and he wants you to apologise for grabbing him...

"What!!?? He steals my paper and then wants an apology?? Is he nuts??"

No...he's deaf...he was born like that...

"Born deaf...or born rude?"

Well...he can't help being deaf you know!!

"Listen...every one has the right to be stupid but tell him that he's abusing the privilege!"

But...in the end...what are you going to do?

Even I can't ethically or morally punch a stupid person.

And fortunately I have already lowered my expectations of life to the point where they've been already met just by me waking up in the morning.

And the operator says '20c more for the next three minutes'

2011-12-14T19:25:00.007Z

There are rules about the telephone in emergency departments...

(1)it will only ring when its very very busy

(2)it will only ring when there is at least a 2 hour wait for a patient to see a staff member

(3)it will only ring during lunchtime when staff numbers are low

(4)no good will come from answering the phone particularly if you give a complete stranger your name

(5)if the phone is answered by a triage nurse or health care support worker they will stand doing nothing at the desk listening to the caller for at least 10 minutes before coming and calling an RN anyway...and then still stand at the desk looking at their nails

(6) 90% of calls will start with the word "Obviously"

So...Thursday morning...and 2 nurses at work with a 2 hour wait already built up by 0900 as it seems to be 'take-your-confused-relative-to-hospital' day.

And the phone rings...

...and rings...

...then stops for the minute it takes to bounce back to the automated switchboard...

...and rings...

Apologising to my patient I grab the phone...

"Good morning...Minor Injuries Unit...how can I help you?"

Is that Bill?

"No...he's not at work today...its Lucien speaking...can I help you?"

Umhh...well I wanted some advice....I was really hoping to talk to Bill...

"Well...he's not here...can I help you!?!"

Well...what it is...obviously...I'm Gillian...

"Uh huh..."

I'm a Community Pharmacist in at the Rigor Mortis pharmacy in Little Armpit...

(the next town along...about 12 miles from us and only 1 mile from St Vulvas Hospital)

...and I wanted some advice about a patient I have here with me this morning...

"Uh huh..."

Well...he's about 65 and he came in and asked us to check his blood pressure because he isn't feeling very well...

"Uh huh..."

And we did it...and its about 80/40...and I think that's a little low...?

"Jah....that's low...does he take any medication of any sort for any reason,medical or otherwise?"

I don't know...

"Can you ask him please..."

Silence

Hello...?...No he says he doesn't take any medication...

"Okay....can you ask him if he has any chest pain of any sort please..."

Silence

Hello...?...He says he doesn't have any chest pain...but he has a 'fluttering' feeling in his chest...and it feels like there is a weight pressing down on his chest...oh...and he is finding it difficult to catch his breath...

"Ok...does he look or feel sweaty or cold and clammy to you?"

Silence

Hello...?...yes he is cold and clammy...

"Okay...I want you to immediately phone '999' and call an emergency ambulance...and whilst you're doing that I want someone else to give him 300mgs of aspirin to chew on if you have it available...

Sorry...?...You want me to call an ambulance...?

"JAH!....I want you to stop talking to me and call an ambulance...it sounds like your guy is having a heart attack..."

Oh...can't I just ask him to drive down to you?

"NO...please just call an ambulance immediately!!"

But I'm worried that you're wrong...and that the paramedics will be cross with me...I don't want to have to deal with that...

"Okay...three things...one...I really don't care what you think...and...two...I certainly don't care what the paramedics will think...because...three...your patient is about to die!"

But what if the paramedics shout at me!?!?

"Then get them to phone me!!"

What's your phone number?

"Well...its either the number that you've just phoned and which we're talking on NOW!!"

"Or...its 0-800-YOUR PATIENT IS DYING!!!"

Oh...

Click.

Pharmacists...really just bartenders with a larger inventory.

The soap can just stay on the shower floor

2011-12-10T23:11:00.006Z

Just around the corner from the Unit is a Fitness First gym...the same gym I go to on a daily basis...okay....maybe 4 times a week...alright...once a month for a haircut...but I digress...

Over the past few years it has provided a steady stream of patients,mostly middle aged men straining or spraining various assorted muscles in their arms as they attempt to get fit in time for their first post-divorce blind date.

And one memorable day when I was actually at the gym someone pitched a fit and fell to the floor unconscious almost in front of me...fortunately I had my cell phone and took the time to call for an ambulance as I sipped my coffee and read the Ethics article in the Nursing Times.

Anyway...as time passed I have struck up a few casual relationships with various MuscleMary types who have endless low grade sprains and who are always seeking medical advice because they have no time to attend hospital as they are too busy with their training regimes of sniffing cocaine,chatting up gym bunnies ,drinking high protein shakes , admiring themselves in the mirror and injecting illegal steroids.

There is one Steroid Monkey who is apparently a porn film actor...and who has apparently made a good living from it....and take that any way you want...(as he said to his co-star)...

*sigh*

Anyway...he is pleasant enough if a little demanding.

A few months ago he asked me if I could inject a litre of normal saline into his scrotum as he had a film shoot coming up and needed to enhance his man-bits.

I declined.

This morning I was trapped in a leg raise machine working on my quads when he sidled up and asked if he could speak to me.

"Whats going on then?"

Well....I was in America a few months ago...and someone offered to inject my penis with silicone...and so I had it done because it seemed easier than the saline injections...

"Was this a doctor or a nurse?"

No...it was someone I met on the shoot...on the 'black market'

"Did they use medical grade silicone?"

I think so...they told me I would be able to mould it to the shape I want...

"Have you been able to mould it then?"

A little bit..

(Don't go there Lucien....just STOP with the jokes)

"Okay...so whats your question today?"

Well...its turned all lumpy and my penis looks deformed...

"Uh huh."

And when my penis gets warm...even standing in the shower...the silicone seems to get bigger and it looks like I've got an erection...

"Uh huh."

And if I try and mould it ,it looks like I'm having a quick wank in the shower...and some people have complained to the manager...

"Uh huh."

Well its quite embarrassing...

"Uh huh."

And my balls are huge and I'm finding it difficult to walk...

"Uh huh."

So I was wondering if you could help me...?

"Well...I think you need to see a urologist and/or a plastic surgeon..."

Okay...

"And I can give you a course of Botox..."

What...?....Botox...Into my penis...?

"No...into your forehead to get rid of the worry lines..."

Bada Bing, Bada Boom...

The Bates Motel...

2011-12-04T18:56:00.016Z

...or the Soulless Inn, St Neots as its more commonly known.

From time to time , I have to travel on business, often spending a night away from home in order to have an early start the next day.

Truth is though, that most chain hotels in the UK are pretty awful compared to those in SA...and often are worse than anything I have yet stayed at in the US or Canada...where at least they wish you a 'happy day' as they treat you with contempt.

The "Basil Fawlty memorial school of Hotel Management" is clearly the training academy of choice for many hotel staff;with a side trip to the Prison Service finishing school for owners of B&Bs'....tiny beds in tiny attic rooms with threadbare towels and 27 different notices admonishing you from having any sort of joy or fun or happiness in the 8 hours that you are locked in the building before released for the "full English breakfast"...a life and death struggle with 13 kilos of hot fat and grease...the following morning,served only between 0700 and 0730.

Nevertheless,being an optimist,I try and enjoy it...I treat a night in a hotel or bed & breakfast as a mini-break,paid for as it is by someone else.

I always have at least five x 30 minute showers...I use all the towels...and I dry my man bits with the hairdryer in the morning...having moisturised them with the free hand lotion the night before.

Okay....sometimes I take my own moisturiser.

WooHoo!!

So last week I was due in Huntingdon in Cambridgeshire,apparently the birthplace of Oliver Cromwell.

The very efficient staff at the agency for whom I occasionally work had booked me into the Soulless Inn in Huntingdon.

The day before my stay the staff from the Hotel phoned to say that they were having an unexpected refurbishment and as such were not able to accommodate me that night and had booked me into their Inn at St Neots...famous for nothing really.

The receptionist told me that there were 2 Inn hotels in St Neots and that I had been booked into the one which was next to the 'Brewers Fayre' pub....and not the one next to the Crown pub.

I don't even really need to write what happened next do I?

I caught a cab from the railway station and found that I hadn't been booked into the Brewers Fayre hotel...but of course into the other one...about a kilometre away...on the other side of a major road...with no pavement or sidewalk.

It was cold, dark and raining and the taxi had long gone.

Hand-to-forehead time.

Fortunately the woman checking in next to me had also been given incorrect details and also had to go to the other hotel...she had a car and kindly offered me a lift which I was very happy to take although the fleeting fear of being kidnapped and used as a sex slave by a group of dumpy middle aged women did cross my mind.

Still....there was nothing worth watching on TV that night so I decided to take the risk.

Some time later I got to the hotel.

It was one of those middle of the road hotels that advertise rooms for £39 a night but in actuality cost £75 a night.

It boasts all the necessary mod cons.

WiFi...for an added cost.

Direct dial phones...for an added cost.

Toothpaste...toothbrush...for an added cost

Freeview TV...only half of the channels work though and the TV itself has a screen of 15 inches.

No bars of soap in the room...no face cloths...

I sensed there was something wrong with the feng shui of the hotel

It appeared to be channelling Colditz PoW camp.

I checked in.

The receptionist was a pale, wan and scared looking young woman who spoke in a monosyllabic tone, and refused to look me in the eye.

She had clearly majored in Passive/Aggressive guest relations.

I was cold and tired and hungry.

"Can I get room service please?"

Room service ?

"Ja...can I get something from room service please?"

Room service...?

I looked at her....she was grinning like a maniac with an bloodied axe in one hand and a head in the other.

"Ja...you know...I order a meal...perhaps a bowl of soup...a sandwich....some fruit...and it gets delivered to my room?"

Room service...?!?!?!

She started to laugh...tears running down her cheeks,snot pouring from her nose...

Room service...oh dear!!

She was on the floor laughing at this point.

It felt like a Tena Lady moment.

I waited whilst she composed herself.

It took some time.

We do not have any food services in the hotel....apart from the vending machine....that has a kit kat in it...no...you have to go to the pub...

"Okay....what about breakfast?"

Yes thats also in the pub...

"Okaaaaaaaaaaaaaaaay....is there any chance of getting some ice?"

No.

"Could I get an iron and an ironing board ?"

We only have one...And its out with a guest...I don't know who...and I don't know when it will be returned.

I phoned her every hour , on the hour and it never was returned.

So I did the old army trick of folding my trousers and shirt and putting them under the mattress.

And like in the army,they were still creased the next morning.

And when I lifted up the mattress, the duvet slipped back and saw the stain on the sheet.

It was dry....I was cold and tried and hungry...and hey...it didn't look too dissimilar to my own bed.

The next thing on the agenda then was dinner...

...which was to be taken in the aforementioned adjoining pub...

...a short walk away...

...but far enough to get soaked in the rain...

...and which was chock-a-block...

...with an hours wait for a table...

...for an £10 burger...

...se moer...

So I schlepped back to the hotel and got a list of local take-away places from the receptionist.

I decided on Chinese.

A prawn chow mein and wonton soup.

The soup looked and tasted like used dishwater with odd bits of unidentified green stuff in it...although bizarrely it smelt of marmite.

The wontons looked like ears that had fallen off of sweaty lepers....slippery and slimy, pale and poorly perfused.

The takeaway came without any utensils.

The hotel had no utensils expect the teaspoon in my room.

Just as well the soup as inedible then.

At least I could identify the prawn in the otherwise bland bowl of worms that was masquerading as chow mein.

And so to sleep.

And as always I was anxious that I might oversleep...and set 2 alarms.

I need not have worried though as my room turned out to be 100m from a major motorway and happily only 30m from the traffic circle/motorway exit...and the lumbering of 18 wheeler trucks all night kept me nicely awake.

Finally 0700 and off to breakfast at the pub next door.

I was the first customer.

Would you like the 'Full English' ?

"Ummmh...no...thanks...I think I'll have the 'continental breakfast' if I can...does that have fruit with it?"

Fruit ?

"Jah...fruit..."

Well what do you mean by 'fruit'...?

"Ummmh...an apple...a pear...an orange...perhaps some fresh fruit salad?"

Oh...*fruit*...

No...

It hasn't been delivered this week...

(This was thursday...seriously...was I the first person to ask for some fruit for my breakfast?)

"Okay then...what does the 'continental breakfast' include?"

Well theres brown bread...white bread...chocolate muffins...cornflakes...three kinds of yoghurt...all-bran flakes...and porridge

I could do you a nice plate of porridge...

"Okay...thank you...the porridge sounds good...very French..."

I decided to make some toast,a process involving putting bread onto a rotating circular wire mesh that revolved inside an industrial toaster.

It took about 1 minute and came out as white as when it went in.

I decided to cycle it for a second time.

About 15 seconds later smoke started to pour from the machine...

...the toast caught fire...

...the smoke alarm went off...

...flames then came licking out from the toaster...

...just as 5 other guests came through the door.

The waitress ran around the pub opening all the doors and windows and I spent the next 10 minutes eating the world's hottest porridge whilst the other guests sat and shivered and made rude remarks about foreigners...whilst pointing at me.

Still since I was the thinest person there...and they were even them shovelling mounds of sausages and beans and eggs and fried bread down their gullets,I felt safe enough...provided I didn't get between them and the buffet.

And then the debit card machine wouldn't work...so at least I got a free breakfast.

And then I went to work.

Advanced Life Support - Part One -Training Day

2011-11-23T19:39:00.005Z

Like Van Morrison, I adore brown eyed girls.

Verily ... visually and viscerally I am only attracted to brown eyed , brown haired women...like Natalie Portman or Jennifer Grey or Eva Longoria...or even my ex-wife....not to mention 'TheMadWomanWhoBrokeMyHeartAnd StoleMyMoney'.

*sigh*

In fact I don't think that I have ever even dated a blonde haired,blue eyed woman...so that percentage of the female population of Europe can now sleep easy!

So imagine my delight when I attended the Advanced Life Support training at St Vulvas last week and found at least five potential 'future-mrs-debeers' in my study group...of six people...I was the sixth!

More than anything else I love...adore...will worship on bended knee even...intelligent, articulate, funny, warm, smart, and,- frankly-, pushy woman...just like all five of the doctors in my group.

The course is intellectually , physically and emotionally arduous...there is continual assessment at each skills-station with the need to demonstrate advanced life saving skills; and there is continual assessment of your knowledge through the medium of the participants running various resuscitation scenarios with the possibility of not being allowed to take the final scenario test.

And the final exam is 'pass/fail'.

I can honestly say that I didn't sleep the night before the course and fell into bed at 20h00 at the end of the first day absolutely exhausted having cried tears of anger and frustration at my lacklustre performance.

Still...in addition to the various life saving skills I might learn , I do tend to see further- or mandatory-training principally as a way to meet women...simply because the main hospital employes several thousand...not all of whom know me!

I quickly established that all of the five doctors were (unfortunately for me) married ,as they swopped photos of their children over the pre-course coffee.

*sigh*

Still...being an optimistic type I looked forward to meeting our mentors,still hopeful I might meet the 'next-mrs-debeer'.

The first mentor was a middle aged male nurse,the CCU charge nurse in fact...now...I tend to think that when men of a certain age...above 25...wear a fu-manchu moustache and dress like a california surfer dude whilst working in a provincial English hospital,that there is probably little they can teach me as they are too busy being "joe-cool".

This proved to be the case.

The second mentor was the ubiquitous 'bald-head-big-ears-oversized-spectacles' male nurse,a resuscitation officer at another hospital...again middle aged...dressed in ageing and faded denim that was seven kilograms too small around the waist....with a clearly unwaxed abdomen...and who was a smoker!!

The third mentor was a dowdy, frumpy and old-before-her-time young woman dressed in a long dress clearly made from recycled curtains she had got from a vengeful and spiteful mother-in-law,festooned with several necklaces made by her preschool children.

But a nice and helpful person as it turned out.

The fourth mentor...well...be still my beating heart...was a tall dark,doe eyed beauty with waves of long auburn hair cascading halfway down her back.

Talking to us,she kept flicking her hair and showing a quick funny smile, her eyes bright with intelligence.

She was simply dressed in peasant type smock and jeans.

I noticed that she wasn't wearing a wedding ring.

This....I thought...has the makings of a very good day.I'm so glad I've washed my man-bits with Dettol soap this morning!!

And then she turned around to write her name and phone number on the blackboard...

...she had a hunchback...

...quite a pronounced kyphosis in fact...

...that explained the long hair.

Still...I'm not actually that much of a shallow and a facile person that I would let a disability stop me from asking someone out on a date.

(Thats someone else's' disability...not one of my many disabilities which frequently stop me from going on dates)

Also....I do have a shovel in my car and the ground is quite soft still.

And...as Hamish McHamish McTavish...our new Scots triage nurse put it in his usual sensitive and tactful manner..."Once you get her rocking all you have to do is stand there and catch her on the down stroke".

And so...two days later...having in fact passed the course....I decided to ask her out.

She looked me up and down and said...

..."Thank you...thats sweet of you to ask...but I I don't really date fat people."

*sigh*

Such a pity because she really rang my bell!!

Oh Sole Mio....

2011-11-22T20:26:00.004Z

Still funny after all these years...the 'Italian food song' will have you crying tears of joy...if it doesn't you probably shouln't be reading this blog!!

I love food...for the unexpected tastes that transport us back to happier times in our own personal narratives...the subtle evocative smells of other peoples cultures that escape from foggy cafes or over laden market stalls on cold mornings...for the actual planning and preparation and anticipation of pleasures sure to come...but more than anything else...for the shared common humanity that a convivial meal of simple tastes and complex friends lends itself too..."I am a human being and we all matter if only to each other"

Some of the best writing on the web is over at "66 square foot" and "voer".

To my mind...and I've said this before...the best food critic I have ever read is AA Gill in the London Sunday Times.

Unfortunately the Times now charges for access to its main website...and so many of you will never be able to read his reviews.

I was particularly struck this weekend by his review of an Italian restaurant and his musings on Italian cuisine...they struck a chord...

...this time one year ago I was in Johannesburg,looking after my brother who had just had major heart surgery...and also...sadly...waiting for my lovely dad to quietly fade from our life...

And I shared many good meals at many familiar places with my children...and ate a lot of my meals with their mother and step father....and standing chatting in the kitchen or at the family table amidst the bustle and easy chat of a shared meal of familiar tastes,the waiting was made a little more bearable.

And so....and I hope the Sunday Times doesn't hunt me down and make me pay...but please find below some of the best writing on food you will ever read.

(I have edited it and indeed re-arranged it a little to suit this post)

We, in the north and the west, for all sorts of cultural, habitual and climatic reasons, eat food that is complicated, with more ingredients and combinations, deeper seasoning, than the Italians.

It’s often said that Italian food relies on simple, perfect, raw materials, eaten for their own a cappella clarity. That’s true up to a point.

But there is something else, something more fundamental in the way Italians eat.

When they taste, they don’t taste what you taste. They’re very Catholic about the orthodoxy of dishes, the correct way of making things.

When they eat, they don’t just eat what’s in front of them, but they taste all the other times they’ve eaten this, and there is the merest hint, a subliminal whisper, of all the people and places they ate it in, and who cooked it for them.

Italians are particularly prone to the comfort and reassuring nostalgia of food.

They eat with a childish verve and enthusiasm, and exuberant remembrance of their homes, their mothers, their lovers and their Vespas.

Italy is a country united by language and religion and divided by almost everything else. What it can boast is a plethora, a diaspora, a minestrone of regional cuisines.

Take the panforte you’re buying for Christmas, a mixture of sugar, honey, nuts, dried fruit, spice and flour baked in a shallow pan.

It’s from Siena.

Not from Tuscany, just Siena, where they’ve been making it since the 13th century. Yet, still, no two confectioners in the same street will agree on an authentic recipe.

And while Sicily has a cuisine completely different from the Dolomites, so one village will make its pasta quite unlike the pasta half a mile down the hill. Indeed, individual families have recipes they guard and swear by that are not to be confused with the neighbours’.

AA Gill

20 11 11

London Sunday Times

Here's a hint...have the shower first

2011-10-17T21:08:00.002+01:00

Sunday morning....after the drunken night before...and I've had to sedate Shuffling Bob the triage nurse...

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

Well...what it is...obviously...I met this bird in the pub last night...

"Jah..."

So we got back to her place...right?

"Jah..."

And we had a few more drinks...

"Jah..."

And we started to f**k...

"Jah..."

And then I started to shag her in the ar*e

"Jah..."

And it was a bit dirty...and smelt a bit...

"Jah..."

So I didn't come...

"Jah..."

So we decided to have a shower...

"Jah..."

And she started to give me a blow job...

"Before or after you showered...?"

After...

"Jah..."

But I still didn't come...

"Jah..."

So then she started to w*nk me...

"Jah..."

And then I came...

"Jah..."

But she had all these rings on her fingers and they hurt my willy...

(Ah sweet....'his willy')

"Jah..."

So its really sore and swollen...and leaking a bit...

"Okaaaaaaaaay then...lets have a look at your willy then shall we?"

What...you want to look at my willy...I'm not a poof mate...

"Well Sir....despite my expensive haircut and aramis cologne....neither am I..."

No really mate....I don't want to show you my willy....I'm not a poof!!!

*SIGH*

"Okay then Sir....I suggest you go home to your new girlfriend and that both of you go to the Genito-urinary clinic tomorrow morning..."

Well...problem is mate...I don't know her name or where she lives...

"Well sir...I would like to help you...but unfortunately my 'Powers' can only be used for 'Good' "

"Bye..."

Oh I do like to be beside the seaside...

2011-09-28T19:02:00.004+01:00

So there I was this morning , on the way to M&S to do my weekly shop...and as I drove slowly through the parking lot,avoiding some of the grannies driving at 5 miles an hour,and some of them wandering aimlessly in an Alzheimer's daze looking for their cars...I spotted this chap sitting in his boat.

I pointed out that the last 'high tide' in our part of the world had been about 160,000 years ago...and that...and global warming not withstanding...there had been nothing on the local news this morning about another flood.

He made a rude remark and carried on reading his Bible...specifically Genesis 6:1 - 9:17

I stocked up on wine...just in case.

Triage

2011-09-17T21:28:00.006+01:00

Saturday 2 July 1988.

About 17H20.

I was at work as a Charge Nurse in the Department of Emergency and Ambulatory Paediatrics aka 'Children's Casualty' , (Area 161) in the Johannesburg Hospital .

We were having a very pleasant afternoon...reasonably quiet,a few interesting cases to keep us on our toes but mostly we were relaxed and chatting.

At about 1700 I walked 'next door' to the adult Trauma Unit Area 163 to see if they needed any help.

The emergency area at JH is a single block with all the Units facing onto the ambulance parking area which is adjacent to the emergency helipad. The Children's Casualty area is on the South side of the block;then the Trauma Unit;then the Medical Emergency Unit (Area 165);finally the Labour Ward (Area 166) on the North side of the block.

It was the middle of winter...and as I walked past the admitting desks (Area 162) I glanced outside and the sky was already dark.I was relieved to see only a few ambulances in the parking area.

The RN in charge of 163 that evening was a cheerful and very competent young woman called Gill...who worked part time in the Unit;and who had a horse.

No conversation was complete without talking about the horse!

I asked her if she needed any help and she asked if I could stitch a face as the plastic surgeons were being difficult.

At about 17H45 we were standing chatting behind the nurses station when the doors burst open and an ambulance crew from the SA Noodhulpliga (a local Afrikaans community version of the Red Cross) came running into the Unit with a man whose legs had been blown off....in a bomb blast at the Ellis Park rugby stadium.

The ANC had detonated a bomb just as the crowds were leaving after a match.

Although we had radio comms with all the local surrounding government ambulance services we didn't have a link to private ambulance services...

And so the first we knew of the bomb blast was the crew pushing through the doors at 163.

It was the fourth bomb in two days in the Johannesburg/Pretoria urban complex;and there had already been about 25 bomb or limpet mine explosions that year which had killed about ten 'black' and four 'white' civilians.

What we did have however was a very well written and frequently implemented disaster plan...actually called "Operation Disaster"...which was initiated (as I recall) by the most senior (full time) person on duty and run by that person and the Head of Department.

I looked at Gill...she looked at me...we decided I would call the emergency since I had long worked in 163 and knew the protocols and that she would go into the Resus Room with the patient since she was the Nurse in Charge.

The doctors then on duty were all SHO's and Registrars doing their training.

I called the Hospital Superintendent and then the HoD, Dr Ken Boffard.

I then called the Duty matrons for Emergency;ICU;operating theater; and for the rest of the hospital.

They in turn had a cascade system calling in their own staff and executing their part of the plan.

Of course,in addition to the formal cascade system,there was a huge informal cascade,where nurses and doctors contacted their colleagues and staff and asked them to come into the hospital.

Fortunately the Emergency Units are in a block on their own and the main staff and public parking is some distance away so there were no problems about getting to work.

My staff in 161 in the meantime were rapidly discharging our patients further into the hospital.

I also called the On-call Pharmacy person...a well known bitter-and-twisted woman who had for many years made the life of Junior Doctors an absolute misery...she rudely asked me on what authority I had dared to disturb her on a Saturday evening.

She was advised to stick her head out of the window and listen to the sirens….that was my authority.

The Labour Ward staff got a little sniffy that we expected them to see non-pregnant-people but we were only sending the walking wounded to them for dressings...and even a midwife can change a dressing.

By 18H00,since so many of the staff lived close to the hospital pretty much anyone who needed to be there, was there by the time the Johannesburg Ambulance service started to bring patients in for triage.

By 18H30 we were very well staffed...staff finding friends and colleagues and quietly and quickly sorting out their roles and equipment.

Although the stadium is only about 5 minutes away in an emergency vehicle from the hospital it had obviously taken the first crews some time to perform a preliminary triage and provide initial care and first aid…also…there were a few car fires that had needed to be extinguished.

By the time the first tranche of patients started to arrive Ken and I were standing outside the doors on the helipad with the "miraculous triage machine"....a battered but sturdy and utilitarian grey metal filing cabinet on wheels,with 4 drawers stuffed with pre-made hospital folders...one for each category of patient...

...Black for those who were dead or who would require too much intervention to be resuscitated...

,,,Red for those requiring immediate resuscitation...

...Green for those needing urgent care...

...Yellow for those requiring a dressing or a broken bone to be set...the walking wounded.This last category also included those who were psychologically shocked.

Most of the ambulances were accompanied by a traffic police car or motorbike...the cadence of their sirens like some Tarantella written by Lucifer...

...and several of them were driven by firemen used to driving big fire appliances,as the paramedics wanted to stay at the scene and continue to provide care to the wounded...

...the ambulances would bounce down the ramp,the red light from their visi-bars bouncing lazily,crazily off of the cold grey concrete...

...they would slow slightly to take the first corner around the helipad, and then start to slow further at the second corner and then shudder to a stop whereupon the doors would be flung open by the staff and the cops.

Ken would look into the back of the ambulance,briefly examine the patient and then call out a colour to me...the patient would then be wheeled into the appropriate area with his paperwork on his chest.

As each patient went through the door they would have different pre-filled resus boxes put on them or on the trolley....IV/fluid sets or airway management sets or dressing sets.

Very quickly we were joined by some senior staff who could take patients directly from us to the Resus Room or directly to theater if necessary;and we were also joined by officers from Johannesburg Ambulance and the Police.

By 19H00 we felt we were on top of the situation and by 19H30 were well into the second and third part of the plan.

By 20H00 relative calm had returned to the Unit...triage had finished as such and my role was then to walk around acting as a facilitator.

Tish Minne, -the Trauma Queen-,was running the Unit and people were starting to scribble notes and tidy up and make plans for follow up treatment.

I remember phoning home to say 'goodnight' to my kids.

At about 20H30 I phoned Charles Tobias who was a member of the Jewish "Helping Hand",a voluntary/charity organisation who did hospitals visits...I asked him to come in and pass out some chocolate.

I remember that he used to drive a green Mercedes and that night his was the only private car allowed to enter the ambulance zone...he always gave the security guards a box of chocolates when he came in on a Sunday to do his rounds...that night was no exception!

Very soon he found me in the middle of a group of patients, and we walked around the various Units giving everyone we saw a bar of chocolate with Charles also solicitously holding their hands and patting them on the arm.

At about 22H00 we were all done and I remember standing outside in the cold drinking some crap coffee,watching Lawrence Katz from Jo'burg Ambulance field questions from the worlds assorted media.

And then the Night Staff had to tidy up and re-stock and deal with the usual Saturday night "Ma slaan vir Pa" ...(drunk mum hits drunk dad).

And three weeks later we did it all again when a bomb went off at a Wimpy fast food outlet...we were not the initial receiving hospital that day but I flew to fetch two children who were critical.

Man...its no wonder I'm so fat the amount of chocolate I've eaten.

A perfect day

2011-09-15T20:37:00.004+01:00

Its been an odd few weeks for me for a variety of personal and professional and spiritual reasons and I am on a much appreciated week of leave.

My lovely son has been living in England since february this year and even managed to get a job working as a Health Care Support Worker in my Unit...he calls me 'Lucien' at work and 'dad' at home.

It has been wonderful having him here and seeing so much of him;he is funny and articulate and thoughtful and is a credit to his mother.

Anyway...today we went surfing...

...he went surfing...

...dad just paid...

So there I was...10m from the beach,perhaps 30m from the ocean...

I had vanilla pancakes with mint-infused raspberries...

...a funny bee trying to eat all the raspberries spent 30 minutes buzzing around my head...

...a very large cappuccino...

...and the Times...

...in the sun...

...with my boy,-see below-,surfing like a natural!!

It just doesn't get much better than this...

The call of the wild

2011-08-25T22:44:00.004+01:00

The patient was a middle aged woman,from one of the many housing estates that completely surround our Unit.

Indeed I often feel like I am working in Precinct 13

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

She held out her right index finger.

Apart from it being heavily nicotine stained,I couldn't really see much wrong with it.

"Uh...whats wrong with your finger...?"

Its bitten,innit ?

I couldn't see an actual wound or obvious bite of any sort.

"Uh...what happened?"

We wuz trying to catch a mice...and it bit me...

"Uh...you were trying to catch a mouse then?"

No...a mice....there were only one of them...

*sigh*

So much for not breaking my diet at work today, then.

Fancy footwork

2011-08-23T19:37:00.005+01:00

Yet another Sunday morning...

Yet another bottle blond, goat-dressed-up-as-lamb patient,smelling of stale cigarette and too-sweet duty free perfume...

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

Well...what it is...obvioulsy...we've been on holiday in Spain for 2 weeks...

"Uh huh..."

And one day I was walking barefoot on the beach...

"Uh huh..."

And I trod on a piece of wood buried in the sand and got a splinter in my foot...

"Uh huh..."

Well...it was quite painful...

"Uh huh..."

Anyway...my husband has one of those Swiss-thingy-things...you know...with the little tweezers in it...?

"A Swiss Army knife..."

Yes...anyway he managed to pull the splinter out...but its been a bit sore since then sometimes...mainly after I've been dancing...

I had a look.

She didn't have a temperature and she didn't feel unwell.

The foot looked and felt normal...not red or warm or swollen or bruised...indeed,I couldn't even see a puncture wound on the sole of the foot...there was certainly no tracking of any sort.

It was simply a normal foot,albeit with a thick heel callus at one end and electric blue nail polish at the other.

"Well...that all looks fine..."

Yes...I thought it was...but I was talking to my sister last night...

...and when she was in Thailand,she got a sand fly in her foot...

...and so I was wondering if you thought I might have a sand fly in my foot...

...you know...they are flies after all...

"Oy..."

"Firstly,she was either bitten by a sand fly...or a 'sand worm' burrowed into her foot..."

Well she had what looked like a piece of red string under her skin...

"That would be what is commonly called a 'sand worm'...which is a hookworm larvae...a sand fly bite causes something much more serious..."

Oh...okay...are you sure...its just that I feel that you're rushing me a bit...

"Okay Ma'am...firstly YOU told me that your husband removed a SPLINTER from your foot..."

"Secondly ,you have a completely normal looking foot."

"Thirdly...there are maybe 100 people at work in England this morning who have seen Leishmaniasis before....'

"Fourthly,- and luckily for you-, I am one of those people."

"Fifthly...I even know the difference between 'sand worm' and filariasis...and whilst I would probably categorise your ankles as being a little 'chunky',you certainly don't have elephantiasis in any shape or form..."

"...you might want to rethink those culottes however..."

"Sixthly...I have also seen and treated 'sand worm' many many times."

"But really....the main reason I am sure that you don't have a worm from Thailand in your foot....is because Thailand is about 6000 miles from Spain."

"Now....I'm sure that Spanish dogs and cats defecate on the beach...but you have a completely normal foot..."

"You might want to rethink those sandals though given your chunky ankles..."

Anatomy 202

2011-08-19T20:01:00.004+01:00

The patient was a young man of 22...fit and healthy...a manual labourer.His girlfriend had insisted that he come to the hospital...a real little 'Miss Bossy Boots'...

Well...what it was...obviously...we was shagging...

"Uh huh"

And when he took his clothes off I noticed the swelling...

I raised my left eyebrow...

"Uh huh"

And I've never seen nuffink like it before...and I'm worried...

I raised my right eyebrow...

"Uh huh"

What do you think is wrong with him...?

"Ummm...wheres 'the swelling' ?"

On his chest...

"His chest?...okay young man...lets have a look then at this mysterious swelling...please take your shirt off..."

Do I have too...?

"Well...its the easiest...indeed...the only way I can actually physically examine you since I'm not wearing my x-ray glasses this morning...go on...take your shirt off...you're among friends..."

He stood up and shrugged off his T shirt (the logo said 'If I wanted to talk to you I would have worn underwear')

(Note to self...try that on your next date)

In fairness he had well developed musculature due to his hard physical work as a road labourer.

Apart from the slight ringworm rash I couldn't really see any obvious problems.

"So...ummm...wheres the swelling?"

There...said Ms Bossy Boots pointing at his left shoulder.

"Well...that's a normal looking shoulder...what specifically worries you?"

The swelling ...there...can't you see it?

"Look...why don't you put your hand on the swelling so we can all make sure we're all talking about the same thing?"

She gave me that look...the look I remember well from my married life...the look that says...dumb arse!!

She stood up and walked over to her boyfriend...and put her hand on his left side collar bone, at the point where it enters the acromio-clavicular joint...in other words...his shoulder.

"Okaaaaaaaay then...well...thats his collar bone..."

Well its all swollen...what are you going to do about it ?

"Nothing...its normal..."

But I've never seen it before...

"Oooohhh yes you have...look at him closely and you will see that he has exactly the same 'swelling' on his right shoulder...as indeed do you...and I...and all the other people living in the entire wide known world."

Oh..so he does...

"Uh huh"

We...all I can say is that I've never seen it before!

You never really learn to swear until you work in medicine.

...on the day on which I get my call-up papers...

2011-08-11T23:04:00.005+01:00

The African Union today adopted a unilateral resolution to deploy army troops and care packages to England as looting and violence spread from London to other major cities. Spokesperson Charity Khumalo said "We can no longer stand by while these savages tear themselves apart."

The AU, meeting today in an emergency session to discuss the ongoing rioting in the UK, has declared that they will do "everything in their power to help bring civilisation to England".

"It's just so sad, you know?" said Khumalo, speaking from the organisation's HQ in Addis Ababa.

"Sitting here and watching them on TV while their society implodes. We cannot in good conscience remain idle and let it happen."

The AU has announced a range of initiatives that Africans can get involved with to help alleviate the misery of the English.

"For instance, we have launched an 'Adopt an English child' programme," Khumalo explained, showing journalists brochures featuring the faces of English kids.

"If you donate a mere R50 a month, you can see to it that sweet little Johnny from Peckham receives a basic education, a pack of condoms and a pair of pimpin' Nikes."

Khumalo also said that the AU would be parachuting in dentists along with army troops as part of a 'Feel better about yourselves, Brits!' initiative.

"You can understand why they're turning on each other," the spokesperson told journalists. "You look in the mirror and you see teeth untouched by modern dentistry. It's heartbreaking enough to make anyone put a brick through a Starbucks."

The organisation also plans to air-drop care packages on major UK cities.

"Vegetables, mainly," Khumalo confirmed. "We're sending them vegetables and toothpaste."

The AU's flagship event, however, will be a star-studded rock concert to be held in Johannesburg, with all proceeds going towards the establishment of mobile libraries around the UK. Artists ranging from Mafikizolo to Steve Hofmeyr have pledged to perform at the show.

"As a humanitarian, it's the least I can do," Hofmeyr said yesterday. "I look at those photos of the adorable little beasts knifing each other in fights over looted X-Boxes and I want to hug them and give them a nice hot cup of Milo."

Meanwhile, the week's events has seen terrified South Africans in London and Manchester packing their bags for home.

"This country is going to the dogs, dude," said Werner du Preez, a gap-year student from Johannesburg. "I've been offered a nice little two-bed place in Hillbrow where I can feel safe again."

Oh well...time to dust off my flak jacket and learn yet another foreign language I suppose.

Shopping in modern England

2011-08-09T14:22:00.003+01:00

I suppose that I've been spoilt.

In all of the riots that I have been involved in,-whether as a rioter or a Peace Monitor or a Flight Nurse-,there was always the guarantee of a swift and vicious response from the police and/or Army which made the day a little exciting.

There was always tear gas;frequently water cannon;typically baton rounds;occasionally live rounds.

It was the "price" of doing business...because if you were rioting about something important to you and the country...like Apartheid...then you have to understand that the State will respond ferociously and immediately.And I was legally and technically a criminal,even if I felt that what I was doing was moral and ethical.

So part of me doesn't understand why the British Police are standing by and letting criminals run amok in London and elsewhere?

I must say that as a guiding principal I have never had much faith is the Police as an organisation.

I am sure that there are dedicated police officers who work tirelessly to make society a better place by arresting criminals;officers who enjoy their work and do it with passion and zeal...but unfortunately they all happen to be traffic cops.

But I believe that most police officers are simply a representative cross section of the rest of society,reflecting the same intelligence and skills base,interest and enthusiasm, as the staff of your local supermarket...or your rubbish collectors.

I believe three things to be true about the lack of response of the police in London:-

Firstly,that they have deliberately not responded to the rioting because they are trying to make the point that the proposed cuts in police numbers would be catastrophic to society.

Secondly,too many of them have bought into the myth that poverty is an illness and that criminals are victims themselves who need looking after...I have just heard 'Sir' Hugh Orde,the chairman of the ACPO ,say on Sky News,that the police response to the burning of houses,ie doing nothing-, was "proportionate".

He went on to say that the police need to be responsive to the needs of the community....really? Really?

What about my community 'Sir"' Hugh?

Thirdly,a lot of them are simply cowards.

Honestly....give me a baton...I'll happily go and hit people who are burning down houses.

I should say for the record that I was arrested when I was 16 for the first time ,in a school in Soweto,by black security cops,for anti-government activity...trying to establish a library in a 'black' school.But at least I could intellectually admire their enthusiasm and zeal in trying to maintain apartheid even if I had no respect for them as human beings.

I remember spending a day with a Commander from the Metropolitan Police in the early 90's,when he had been sent out to South Africa as part of a European Union team to teach the SAP how to be better policemen.

He was spending a day with me,as a Peace Monitor,because he was tired of being shot at by the locals- (ie the ANC/PAC/IFP)- and laughed at by the police.

He told me the following story.

He was sent to Durban and spent the day with a platoon from the "Public Order Policing" team.

He was in an Nyala armoured car,a beautifully sprung and air conditioned vehicle manufactured by a leading German car company,-see the picture at the top-,and was in a township adjacent to Durban.

(Now I should also say for the record,that my idiot brother was an Inspector in the Riot Police,and routinely drove around with 500 hand grenades and 5000 shotgun shells in his vehicle...for 5 cops)

He was dressed in a white uniform shirt and dark blue uniform trousers.

The South Africans were dressed in camouflage and bullet proof vests.

They drove to an area where a large crowd had gathered ,were tires were burning and people were chanting resistance songs and slogans and were happily toyi-toying.

The Lieutenant in charge of the platoon told the Commander that he would tell the crowd over the tannoy that they had 5 minutes to disperse...and that if they didn't comply in a timeous manner,that the police would open fire with general purpose machine guns.

No no , said the Commander. That was "old style" policing.

Let me show you the new way to police disturbances.

He asked the Lieutenant to open the door.

The Lieutenant looked at him...looked at the driver and shrugged.

The Commander stepped outside and held up his right hand.

As he started to speak, he was dismayed to see several quarter-bricks;half-bricks;whole-bricks;petrol bombs;and even a few assegais come rapidly down on his exalted, new style policing head.

A hand reached out and pulled him into the safety of the Nyala...and the police opened fire with everything at their disposal.

The Commander never offered his advice to anyone again.

The $64 000 dollar question

2011-08-08T20:29:00.001+01:00

The patient supposedly had a head injury.

I was asking him the time/place/person/prime minister/monarch questions.

"Okay...do you know where you are?"

What...right now?

"Jah..."

Oh...well in hospital with you...

"What do you think my job is?"

What do you mean...?

"Well...do you think I am a police officer...or a bus driver...or a vet...?"

Ummmhhhh...well...your badge says you're a nurse...?

"Okay...do you know the name of the monarch?"

Whats a "monarch" ?

"The Queen...of England... if that's any help...?"

No mate....that's not my subject...

Go on...ask me anything about football...

Ask me who Fabio Capello is...go on!!

"Okay...who is he?"

Well...strewth mate....he's the England football team coach...you don't know that....and you think I'm confused...

He laughed.

His idiot girlfriend smirked.

"So...the Queen is not your subject....well...thats unfortunate because I think you'll find that you are her subject."

I smirked.

"I'll give you a hint...her head is on most of the stamps and currency..."

Sorry mate...I think it involves someone called 'Charles'...and maybe someone called 'William'...does that help...?

I decided it wasn't so much a head-injury related confusion as much as just plain old fashioned stupidity.

Am I going to be okay?

"Well...as long as the government doesn't make you pass an intelligence test to draw your unemployment benefits,I think you'll be just fine..."

Tri Nations Misery...Try harder

2011-08-03T09:17:00.003+01:00

I was facing a problem deciding who to support this past week-end... Bafana Bafana or the Bokke?

So I took out my yellow Bafana Bafana shirt...

Then I took out my green and gold Bokke shirt... I still could not decide!?!?!?!?

Suddenly I had a brainwave...

I cut both shirts in half, length-wise and sewed the two halves together...

Brilliant!!!!!

Now I have one shirt to support both... ... and proudly displayed across the front...

The Elephant Man

2011-07-30T19:48:00.005+01:00

"If I could reach from pole to pole

or grasp the ocean with a span

I would be measured by the soul

the mind's the standard of the man"

Poetry quoted by Joseph Merrick

So I have been on a little break from work for 2 weeks...really just needed to get away from all my crazy ,demanding, lazy, rude colleagues.

Don't get me started on the patients!

On Thursday, my son aka The Monkey King,-who is working in the UK for a year-,(Yea!!)- and I went to London for the day...partly to do some sightseeing...partly to do some shopping...partly to go to a few museums...but mainly,to have dinner at the Spur steak house!

Anyway...we decided to visit the museum at the Royal London Hospital because it contained artifacts from both the Jack-the-Ripper murder hunt and the life and times of Joseph Merrick,the Elephant Man.

The hospital which is now a huge sprawling campus, is in Whitechapel,right in the heart of Jack the Ripper territory.

Its a small museum but is chock full of simply amazing objects including original crime scene maps and anatomical drawings from the killing of Mary Ann Nichols,the first victim,showing her stab wounds and the degree of evisceration.

On a lighter note...well...certainly on a more humane note,there is a hood that Joseph Merrick is alleged to have worn when he was out in public.

Merrick's hood

A letter written by Merrick to a benefactor...

...(please excuse the poor quality of the photo)...

And then ,just around the corner from the museum,and only 30 meters from the main Accident and Emergency entrance is a charming pub...staffed as usual by whiny New Zealanders and full of morose hospital staff.

The Good Samaritan pub,Whitechapel.

And then on the train back home I got to wondering about the possibility of a fashion tie-up with some of the online dating sites...so many of the people I meet are so ugly I could probably sell them an Elephant Man mask to wear on the first date.

From the top to the bottom

2011-07-20T19:26:00.003+01:00

Another busy Sunday and a never ending stream of patients,most of whom are the "worried well" ;the "old-and-confused-but-still-managing-to-be-rude"; or...well...honestly...the "just mad".

I was coming to the end of examining a taxi driver who had pain in his right ear for 4 days.Like most of the local cabby's he was from Eastern Europe and thus felt more entitled than even the local yokels to a full and free examination when it suited him...clearly someone else who thinks that "Emergency" is a Latin word that means 'go to hospital whenever its most convenient for you' !

I was coming to the end of a full and comprehensive examination which I knew would yield no surprises...but you know...'thoroughness' is my middle name.

Actually my middle name is probably 'rude sod',but lets not quibble !

So...what is wrong with me ?

"You have a mild external ear infection....its called an otitis externa...take the prescription to the chemist...use the drops....and it will settle down"

He stood up and started to walk to the door.

He didn't bother to say 'thank you'.

I didn't bother to say 'good-bye'.

I started to finish my notes.

Can I just ask you one other thing?

"Jah...?"

Well...when I was having sex last night, my wife said that there were some things sticking out of my bum...

"Uh huh..."

She didn't know what they were...

"Uh huh..."

Do you know what they are...?

"Well...since I'm not sure what vantage point your wife was in ,that she was looking at your bum during sex...

...and since you've got your clothes on...

...and since you haven't even bought me a lobster dinner...

...then,-no-, I don't know what it might be..."

"Drop your pants and lean over the bed and I'll have a look..."

What....? You want me to take my pants down...?

"Jah..."

Do I have to?

"No...you don't have to....but if you want me to determine what it is that is sticking out of your bum, then its the only way I can do that..."

Okay...well...it just feels a little strange...

"I'm sure your wife said the same thing..."

What?

"Would it help you if I dimmed the lights and told you that I will still love you in the morning?"

What does that mean?

Oh the joy of having patients who don't understand colloquial sarcasm!!

"It means that I will use a lot of KY jelly..."

My eyes are still watering...

Hot ! Hot ! Hot !

2011-06-28T15:55:00.006+01:00

I have always believed that there are many many advantages to being married if you are male...

...the most important one of which is that your wife doesn't let you go out in public when

you are "dressed funny"

Poor 'Shuffling Bob'...this is how he dressed on the hottest day of the year.

NASA phoned to say that they had to recalibrate the Hubble telescope due to the glare from his pale white legs!

By 1500 the temperature in the Unit was 27*C.

We do not have any air conditioning because apparently it wasn't cost effective since most patients are expected to be seen and treated in a couple of hours.

The fact that staff are there for a minimum of 8 hours and a maximum of 14 hours is completely irrelevant to the bean counters.

And so at about 1600,-having already had a shower at 10h00 and at 13h30 whilst on meal breaks-,I saw a charming happy 8 year old boy who had broken his wrist whilst he was playing at the beach.He was unconcerned by the fracture and the plaster we had put on his arm.

He had a rash of freckles across the nose and was wearing an ice cream stained t-shirt.

His father,looking like an over broiled lobster rejected by Gordon Ramsay,was wearing shorts and an equally ice cream stained t-shirt.

I was typing up the notes for fracture clinic.

So,said his father,its been a beautiful day today...stinking hot at the beach.

"Uh huh."

I don't remember when it was last so hot...1976 I think they said on the telly...

"Uh huh."

It's so hot we almost didn't have to light the barbecue...!

"Uh huh"

Nothing like eating steak at the beach is there...?

"Uh huh"

It was really difficult to keep the beers cold...

"Uh huh"

Some good looking girls in bikinis...!

"Uh huh"

It was so nice to have a swim...the water was just perfect...!

"Uh huh"

So...are you going to get a chance to go to the beach today?

"No."

Oh...what time did you start work...?

"0745."

Ohh...what time do you finish...?

"10 o'clock tonight."

I typed for a few more minutes.

"So...what will you be doing at 8 o'clock tomorrow morning ?"

Ugh...don't ask...Monday morning...I hate Monday mornings...I'll be stuck on the motorway somewhere trying to get to work...!

"Uh huh...because I was just thinking....I'll be in bed..."

Oh...

"Ja....I never work on Monday mornings...'

Oh...

"So I'll get up at about 10...have breakfast...and then go to the beach for the day...my apartment is only about 3 minutes walk away from the beach..."

Oh...

"So I'll probably just sit at a pub and drink and eat and read all day..."

"Maybe watch some Wimbledon on my iPad..."

"Ja...and I'll do the same thing on Tuesday...."

"Ja....and I'll probably do the same thing on Wednesday..."

Oh...

"So...I think that's 'game set and match' to me then?"

Satan goes 10 pin bowling

2011-06-07T16:41:00.005+01:00

A beautiful Saturday afternoon in our little Jewel-in-the-Crown...and so there was a 3 hour wait as the locals wanted a trip out for the day...and couldn't afford the bus fare to the beach.

"Ms Kommunion ? Ms Holly Kommunion ?"

A pale , thin,40-ish spinster unfolded herself from the chair and folded up her copy of "Cats and the single woman weekly".

Despite the sunshine,she was carrying an umbrella and wearing a pale purple woolen cardigan.

Her grey hair was cut tight around her head,as if to keep any evil thoughts from entering her mind by osmosis from the hoi polloi surrounding her.

She looked like a stick insect that had been dressed by Picasso...from his "spinster-of-the-parish" period.

She appeared to be the only person in the waiting room who wasn't using a mobile phone.

"Good afternoon...sorry for the long wait today...what can I do for you then?"

It's my knee...I've injured my knee...

"Uh huh...what happened?"

Well it wasn't my fault...

...I was in Church last week...

...in London...

...I went up to hear an Irish priest speak...you know...she simpered slightly

"Uh huh..."

Well...there I was...standing up for the prayers...

...minding my own business...

...and there was a Black woman standing next to me...

...and you know what they're like...

I raised my right eyebrow.

You know...Black people...

...they're all fat and stupid...

I raised my left eyebrow.

I suppose it wasn't her fault though...

I raised both eyebrows.

You see there was another fat stupid Black woman standing next to her...

...and she fell over first...

...and knocked my fat woman over into me...

Keeping both eyebrows raised I leant back and crossed my arms.

I don't know what was wrong with the first fat woman...

...there were 5 or 6 people helping her after she fell to the floor...

...and then some paramedics...

....they were making a lot of noise...

...you know how much noise Black people make...

...I could hardly hear the prayers...

I took a deep breath and sighed.

So you see it had nothing to do with me...

...there I was,minding my own business and these fat stupid Black women fell into me and I twisted my knee...

So...she said triumphantly...what do you think is wrong with me?

I regarded her quietly for a few minutes.

"Julian...please bring me a bottle of sterile water...asap!!"

He did...and stayed to watch.

I made the sign of the cross over the bottle and said..."In nomine patris, et Filii , et Spiritus Sancti...Amen"

What are you doing...?

"I'm blessing this water..."

Why...?

"Well my working diagnosis is that the milk of your human kindness has curdled...

...and my differential diagnosis is that you're possessed by demons..."

She look startled...

"Either way I think you need to be exorcised!"

I opened the bottle and prepared to shake it over her...either that or add some Gin.

And, "Yes dear reader"...she filed a complaint.

Guess how much it bothered me...?

Answers on a postcard to the usual address...

The patient was more confused than I had realised...

2011-06-06T19:00:00.004+01:00

...since this is what she wrote on the 'Patient feedback form' on Saturday.

And...no...I didn't tell her I was a doctor...I make it very clear that I am a nurse when I introduce myself...

Darn!

I should have got her phone number...

...I could have sent her to an English 101 class!

....in which I discover a new syndrome....

2011-06-01T23:41:00.007+01:00

Sunday morning bright and early...almost summer.

I'd even heard some bird song as I parked the car.

The waiting room is packed however.

"Mr Pease ? Mr Herb Pease ?"

A pale,visibly hungover 50-something man stands up gingerly from the cheap plastic waiting room chair.His eyes are bloodshot,he is unshaven and his greasy ponytail hasn't seen a comb for a few days...he is clutching a takeaway coffee container form McDonald's with an intensity that makes me wonder if it is the Holy Grail...and both shambling (with his good leg) and limping (through his bad leg) slowly makes his way into the Unit.

He had clearly had a good evening with his three best friends...Nick O'Tine, Al Cohol and Gay Abandon.

To be fair to him,its like I'm looking in a mirror...except I had had a shower sometime in the past 72 hours.

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

Well...what it is...obviously...its my knee...I hurt it last night...

"Uh huh...what were you doing...going for a run...playing rugby...?"

Ahhh...no...it was my 50th birthday party...and we had a disco...and I'd had a few drinks...

...and I fell over when I was dancing and hurt my right knee...

...and its still so painful...really really painful...

"Okay...how much did you drink ?"

I can't remember...

"Okay...did you stop dancing when you fell over ?"

No...I was having such a good time...and you only turn 50 once don't you...?

"Have you taken anything for the pain...any analgesia at all?"

No....I don't like taking tablets...

*sigh*

"Okay...if you could just take your shoes and socks off...and then your trousers...and hop up onto the bed please..."

Do I really have to take off my trousers...?

"Jah...this is why your mother always told you to put on clean underwear..."

Maybe he had listened to his mother at the start of the evening...it was a real pity though that he hadn't been home to change...just as well I am a vegetarian.

He made himself comfortable and I started to examine him. I was reassured that he could fully weight bear through the knee;that he has a full range-of-movement through the knee;and that he could straight-leg-raise.

He certainly appeared to have what is called "global" knee pain.

However his knee was not warm to the touch or red or even swollen;there was no obvious effusion;there was no bruising;he had no bony pain;and all his ligaments appeared intact although he had some pain to the specific test for his medial collateral ligaments.

We were both sweating a little at the end of the consultation.

Him from fear...and pain.

Me from the second hand alcohol fumes.

"Right...well...I think that you've sprained your knee when you fell over...there's really nothing else to find...and you need to rest it and ice it and take some pain tablets..."

But its really painful....really really painful...

"I'm sure it is painful...but...with respect...you're quite a big guy...and dancing on an injured knee is always going to end up in tears...and that's why I want you to take some pain tablets..."

But I'm a builder...how am I going to manage at work...?

"Well....and I'll try this again in English...rest your knee...ice your knee...take some painkillers...and probably take a few days off work..."

Are you sure its just a sprain...?

What am I going to tell my wife...?

(Really...you found someone to marry you...let me make a note on your chart)

"Jaaaaah...I'm 100% sure its just a sprain..."

Don't I need an x-ray...?

"No...you sprained your knee...you continued to dance on it...and now that you've sobered up you're experiencing some pain..."

Are you sure its just a sprain...are you sure I don't need an x-ray...I'm just worried about my job...thats all...

"Okay...I'll tell you what...I'm going to give you some codeine and leave you for an hour...

...and then I'm going to do an old Army knee stress test...

...we used to do it on a Monday morning when the troopers had returned from their Saturday night in the discos...

...I guarantee that if you can pass that test that there is nothing sinister going on in your knee and that you only have a small sprain..."

Julian settled him down with some 'fresh' chemical coffee and some codeine and I left him alone for an hour.

"Right Sir...please get up off the bed and stand over there next to the wall..."

He duly did that...and in a relatively pain free fashion,the codeine having kicked in already.

"Right...now...with both feet firmly on the ground,looking straight ahead,I want you to stretch out your right arm to your right side,and place your right hand firmly against the wall to balance yourself...Okay...?"

He duly does this as well.

"Now...I want you to put your right leg out in front of you,as if you were going to step over a small step..."

He duly flexes his hip...his knee..and his ankle.

Still relatively pain free.

"Good...now...keeping your leg in that position...and keeping your hand on the wall to balance yourself...I want you to point your toes forward...as if you are going to press down on the floor...Okay ?""

He manages that as well.

"Okay...now I want you to make that a nice fluid movement...bend your hip...bend your injured knee...then bend your ankle... and then point your toes down and tap the floor...Okay ?"

He manages that as well and looks expectantly at me.

Gosh...that's not bad is it ?

"Wait Sir...there's more to come..."

"Now...I want you to make that movement several times a minute...basically as quickly as you can..."

Hip/knee/ankle/point foot and tap toes

He managed about 16 toe taps.

"Now...the next part is crucial...the next time you bend your hip I want you to raise your left hand above your head and say...as loudly as possible...'Staying Alive' ...Okay ?"

Why do I have to do that then...?

"Well...firstly I want to check your balance...and secondly...I want to distract you from the pain...and shouting out 'Staying Alive' and raising your left hand will do that..."

Oh...okay...what does 'Staying Alive mean ?"

"It doesn't mean anything....we just wanted the troopers to...you know... 'stay alive'.."

"So...bend the hip...raise the arm..bend the knee...shout 'staying alive'...bend the ankle...tap the toes ...and do it as quickly as you can...."

Hip/arm/knee/'Staying alive'/ankle/foot and tap toes

And he managed to do it 9 times in the first minute and 12 in the next minute and attracted quite a crowd with his 'staying alive' shouts echoing throughout the suddenly quiet department.

Even Julian felt sorry for him then.

"Okay Sir...how do you feel...?"

Well I feel better now...that was a really stressful test...I'm sure if it was broken I couldn't have done that could I ?"

"Good...so I can really confirm that its just a mild sprain...or a "Travoltaitis"...as we call it..."

What regiment were you in...?'

"The Queens Royal African Deserters...our motto was 'Voetstoets or Voetsak' "

What does that mean...?

"Basically...take responsibility for your own life and get out of my emergency room..."

"Well...thats the polite version anyway..."

What begins with T,ends with T and is filled with T ? A teapot.

2011-05-31T17:43:00.006+01:00

Saturday morning,and Shuffling Bob,- the Triage Nurse-,came out of his little office,and with his usual lugubrious manner , shuffled the patient admission forms at the three of us sitting at the nursing station, like a demented blackjack dealer at the Grand Gomer Casino where the stakes are always either your sanity or your soul.

Who wants what?

"What lucky contestants do you have for us today then Bob?"

Well...I have an ear...a possible UTI...and an ankle...

"Well...let me take the ankle...I think that I'll start at the beginning of the alphabet and see how far I get through it today..."

And so the day started.

By 10h00 I seemed stuck at 'P' for "PFO"...a seemingly endless cavalcade of nubile teenagers who had been out drinking and dancing and drinking and wearing high heels and drinking and falling over.

By 11h00 I was up to "R"...as in "R" for "rist" as the patient put it on the admission form.

Its really difficult to think that there is actually free education here in the UK.

Or maybe...the Ministry of Education doesn't understand that the concept of the three R's of education ,- 'reading,riting and rithmetic'-,is not an actual example of spelling.

Of course ,the UK teaching profession appears to have adopted a post-ironic approach to education,where the emphasis is on such vital and socially inclusive subjects as 'life-skills', 'citizenship' and underwater basket weaving.

Its not for nothing that the teachers Union is called NUT !

I digress.

The patient with the 'rist' injury was a cheerful schoolboy of 11 who had fallen out of a tree on Wednesday...and who had a deformed looking wrist,which was bruised and swollen.

"Okay...any reason why you've waited three days before bringing your son in for treatment then Ma'am ?"

Well....what it was...obviously...I didn't think it was broken...and I've been giving him paracetamol...but it hasn't brought the interest down...

"I beg your pardon...the paracetamol hasn't 'brought the interest down' ?"

Yeah...you know...he's still in pain...

Oy.

Needless to say...his wrist was broken.

Which took me to "S"...for "Social Services"...to file a cause-for-concern form.

Just before closing I got as far as "X"...for 'eXtra' elbow...

...the final patient was a pale and wan 9 year old who had been playing in the garden under the supervision of a babysitter and who had fallen and broken his arm...he had snapped his radius and ulna,-the two bones of the forearm-,completely in half and the middle of his right forearm was bent at such an angle that it looked like he had an extra elbow.

He walked in holding his right wrist in his left hand.

His mother,-a woman who was a size 30 but dressed as if she was a size 8...who was in her 40's but behaved as if she was 14-,came trailing in behind him talking on her cell phone.

As usual.

He promptly vomited all over the desk and floor...which his mother did her best to ignore.

He also vomited down the sling I had put his arm in...which his mother also ignored.

She completed the paperwork still on the phone whilst he was weighted and given some analgesia...and a new sling was put on.

She was still on the phone when he went for his x-ray.

I'm at the hozzy...the man is looking at Johnny...I heard her say.

The on-call orthopaedic doctor was just so delighted to get the referral at 22h 45.

Back to 'F' in the alphabet then .

Who's your daddy?

2011-05-21T23:21:00.003+01:00

The patient was a 19 year old University student...

...she is studying English and Media Studies...

...(whatever that is!)...

And she had put her dad down as her 'emergency contact'...

I asked her if she thought he was an a*sehole?

She didn't think the joke was funny either.

*sigh*

BTW....just love that PicSay app !

Just in case Saturday ends up being Judgement Day...

2011-05-20T22:38:00.008+01:00

...as a lot of people believe it will...when "The Rapture" happens tomorrow at 1800 Eastern Time...

...(that's the time in the USA,-naturally...)

...then please...

...have a 'borrie' roll and relax...

By the way...if you are one of my colleagues then do not phone in sick...

...there is no doubt in my mind that there is not one single one of you who will be going to heaven...

Also...don't phone in and say that you cannot get to work because of the zombies wandering the streets...

...or that the only food available in McDonald's was Manna...and that it tasted too sweet...and that you think you're allergic to it...

Also...don't phone in and say that you joined the Universal Life Church on Friday night and have been saved and therefore no longer need to come to work...

PS....the fridge magnets are for sale...a limited edition of 20....so make me an offer!

PPS...I believe that there is something out there watching over us-the Government.

PPPS...I still miss you so very much...you know who you are

*sigh*

PPPPS...pass the mustard please...

The blind apparently actually leading the blind

2011-05-16T18:24:00.003+01:00

So the recession has caught up with me...

I need a second...and possibly a third and even a fourth job...to meet all the bills for the exotic lifestyle to which I aspire...

...paying for bread...

...potable water...

...sniffing coke from the pert peachy buttocks of a teenage hooker...

...okay...actually just my utilities...

So there I was this morning,in a strange building for an interview...and looking at the information board I was amused by the listing for 214...

The test of good manners is to be patient with bad ones...I failed

2011-05-15T07:13:00.001+01:00

"Mrs Burns ? Mrs Myfanwy Burns?"

A tall,thin, well dressed older woman stood up and walked towards me guarding her left arm .

She looked like a praying mantis,with a tight cap of purple hair and large glasses offset by an angular face with a small chin.

She followed me into my examination room.

"Good evening Ma'am...what can I do for you today then?"

Glaring belligerently at me, she waved her left hand in my general direction.

I sat there looking at her.

Many patients do this and I always ignore them...I'm not actually a vet...you have to talk to me if you want me to try and guess what might be wrong with you...and since I get paid by the hour and not by the patient,I can sit and wait out your rudeness longer than you can wait your your pain.

I sat.

She sat.

I sighed.

It was supposed to be a treat ,she snarled.

"I beg your pardon?"

My stupid daughter thought it would be a treat...

I just sat looking at her.

She took me out for 'afternoon tea' at a fancy hotel...

"Yerssss....?"

Well...she wanted to sit outside in the sun...

"Yerssss....?"

And it moved...!!!

"The sun moved , you mean?"

Yes...she spat...the sun moved and I ended up sitting in the shade...

"Right...so the sun moved...like its done every day since...oh...I don't know...the beginning of time perhaps...and you ended up sitting in the shade...go on..."

Well I decided to dragged my chair from the patio onto the grass and I fell over...and injured my wrist...

"Okay...it certainly looks dodgy...lets get an x-ray of that for you..."

I don't think its broken...I'm only here because my stupid daughter insisted I come...

"Well...I do think its broken...but if you don't want the x-ray that's also okay..."

Well...I've waited so long to see you this evening that I should probably have it then...

She had it.

She had broken her wrist.

I'm glad I'm not her daughter...

...or husband...

...or orthopaedic surgeon...

Julian demanded danger pay for putting her in a plaster cast.

I offered him half a kit-kat.

He accepted.

Total body crumble

2011-05-13T18:20:00.005+01:00

To the Hon Casualty Consultant

Thank you for accepting this 71 year old male patient who has a number of acute but cross-discipline medical problems , most of which require intervention;however apart from a referral to psychiatry,I am not sure where to start.

He has just returned this morning from a two month holiday in Thailand;in fact he drove directly from Heathrow to our Minor Injury Unit.

His presenting complaint is acute urinary retention;he has not passed urine for 37 hours.I have inserted an indwelling catheter and gradually emptied his bladder of 3 litres of turbid and offensive smelling urine.

I have sent a sample to the lab for MC&S.

During catheterization it became obvious that he has an acute prostatitis.

Fortunately the catheterization didn't hurt me.

He reports that he has had five bladder infections in the two months for which he received over-the-counter medicines,possibly antibiotics.

It would appear as if a new UTI has partly precipitated this retention episode.

He also has genital warts which he apparently didn't have prior to his trip;and also has what appears to be a chancre.

He reports,-quite proudly,even gleefully-, that he had sex with over 80 different prostitutes in the two months.

He is also jaundiced and has a large , and painfully palpable liver.He says that he drank a litre of whiskey a day for the two months, in addition to his 'normal' beer intake.

His liver is so large that I expect he had to pay excess baggage when he flew back.

And he thought his jaundice was sunburn.

My main concern however is that he also has a central chest pain with some new ECG changes.He reports that he has taken a Viagra a day for the holiday period.

I have told him that there is nothing that can be done for his greasy grey ponytail apart from cutting it off and giving it a decent Christian burial.

Kind regards

Lucien

Cut-and-paste sick note...

2011-05-13T18:18:00.003+01:00

...not sure how successful this would be in New York but its a perfect excuse for most of my patients...

Wrong number

2011-05-06T11:32:00.003+01:00

The patient was a 26 year old male, expensively dressed,sitting in the waiting room talking on his cell phone.

"Mr M'Ballz Es-Hari ?"

He looked at me,continued talking,and did a little wave of his hand that I took to mean I should wait for him to finish his call.

Letting a little tone and hardness creep into my voice..."Mr M'Ballz Es-Hari..."

He looked at me,grimaced,then stood up and followed me into the Unit.

My consulting room is about 25m from the door.

I could hear him talking on his cell phone whilst he walked behind me.

"Right...please have a seat Sir...what can I do for you today then?"

He sat and carried on talking on his phone...and again waved his hand in my general direction.

'Okay...buddy....either switch off your phone and pay attention....or get out of my emergency room..."

(I love saying that although he didn't technically meet all the requirements of being a GOMER)

I'm talking to my father in Saudi Arabia...!

"I don't care who you're talking too...if you don't have enough manners or sufficient courtesy to stop talking...then...really...get out of my emergency room...there are plenty of patients who do want to be seen today..."

He jumped up from the chair,raised his hand above his head...and threw his BlackBerry to the ground...where it broke into 5 separate pieces.

Result.

There...are you happy now...?

"Deliriously happy...now...why don't you sit down and tell me whats wrong..."

Imagine his fury when I decided that he had a viral throat infection and wouldn't give him any antibiotics....despite the fact that his father is a Sheik...apparently...

Its just been a week for Royalty...

Me and the aristocracy

2011-05-05T14:34:00.005+01:00

The royal wedding last week reminded me of an incident when I was working an overtime shift at St Vulvas in the Emergency Department,one Saturday afternoon a few summers ago.

I was the designated "resus nurse" and as such got to play with the really interesting...or, sick....patients.

Joining me for the afternoon was a South African doctor called Grant,a real laid back surfer-dude from Durban...with assisted-blond hair gelled into an improbable shape...a generous personality...and a happy disposition.

A local ambulance crew came storming through the doors with a middle-aged woman having a full-on allergic reaction to a bee sting.

Her very anxious looking husband came running in behind her.

She was pale and sweating and having difficulty breathing and was a few minutes away from respiratory arrest.

Okay my dear....a phrase anyone under 30 uses on any woman over 50 in an ER...my name is Grant...this is Lucien....and we're going to be taking care of you.

She tried to smile and nod her head.

Her husband stood in the corner,staring in horror as Grant stopped chewing his gum long enough to talk to her...

Howzit, he said to the husband.

Dude...have you got a line in ? he asked me.

I did ...whilst he checked her airway and started to give her the necessary drugs.

Gradually her colour returned to pink,her breathing slowed down,and her pulse and blood pressure normalised.

At this point one of the full time staff nurses bustled into the resus bay with the paperwork and said to us...

...This is a Lady...

Grant looked at her,stopped chewing his gum again,and laconically replied...

...I can see shes a lady...I passed my anatomy at university...

He winked at me.

We both laughed.

No, said the staff nurse...shes Lady Horseface of Richfromslavery...

Oh, said Grant. An actual Lord and Lady, hey?

The patient gave a slightly embarrassed smile.

So...are you rich? asked Grant.

I too was curious.

Hurrmph....well...yes....I suppose we are...said Lord Horseface.

Great...do you have any daughters?

Hurrmph....well...yes...we do as a matter of fact...

Great...are they single?

I thought we were going to have to resuscitate Lord Horseface as well.