grab the yoke from the pilot and fly the whole mess into the sea

the votes have been cast, the panel has been ruminating behind closed doors. months of hard work, extra hours after school, meticulous notemaking and detailed tome reading are over.

sadly the royal college of physicians have given me a nice big fuck you with another failed exam.

it would have been nice for a lift. it would have been nice for a bit of achievement to end the year with. but no.

i'm not entirely sure what to do now. i've always been one of those people that has to study hard for results (there's not a lot natural about me) and when i haven't it always shows. this time was different because i worked my little cotton socks off. it's difficult to know how to improve on that.

maybe this is the wall! medical gandalf standing in my way bellowing "you shall not pass."

i have had lots of kind words from friends and colleagues - it's quite funny in that the response is almost like that to a bereavement.

anyways.

as i remind the friends who i am worried feel i might go and top myself, i bought a REALLY big christmas tree (far too big for my flat) and decorated it yesterday with not one, not two but three sets of fairy lights. and i did score three strikes bowling on thursday night. i am good at a few things.

i'm sure a weekend of nights will make things look better.
[i am listening to Regina Spektor again]

gnarls barkley

i have had the pleasure this week of meeting up a few times with another good canadian buddy, Dr Gnarls Barkley (his real name is VERY similar and i think that's hilarious). i first met Gnarls in his capacity as best man and organiser of a stag night for another good friend in vancouver last year.

happy days, with much meat, beer and rye consumed (not always in that order) and the town was set alight. that whole holiday actually supplied a good few anecdotes for the next few months. happy days (tear wiped from left eye).

over the past week he has accompanied me to the BJM at the Astoria and also a great dinner this weekend with his sister, brother-in-law and their fantastic new baby boy.

perhaps somewhat unfairly, Dr Barkley gets tarred with the hellraiser/nutter/crazy mofo brush because of many many historical exploits that he and the groom became embroiled in through university and beyond. i empathise with him as i too often get similarly tarred. Dr Barkley merely likes to let his hair down when he manages to have the time.

in his "normal life", he is an attending physician (read consultant NHS fans) in emergency medicine in Edmonton in Alberta, Canada. in a ferociously busy department, he works bloody hard, does lots of night shifts whilst not losing his humanity or sanity. he's also blessed with good looks (ten quid in post i'm told), a fabulous apartment and a handsome paycheque to take home at the end of the month.

despite being at the top of his game, i wonder if something changed in him over this and/or last year. (having said that i only met him in Sept 05 so it may have been brewing for a while before that). this perceived change culminated in him packing up his alberta life for a while, moving to London and pursuing a Diploma in Tropical Medicine at the London School (very prestigious, very difficult to get into.) during this course, seeds that had already been sown began to flourish and just under a year later he is preparing to quit his job again and head off as a volunteer with Medecins Sans Frontieres to Africa.

i have nothing but admiration: respect for him as a senior colleague and pride that someone i know can be brave enough to undertake such a noble odyssey.

and once again it triggers me to ask "there must be something more" than negotiating the depressing quagmire of exams/job applications/specialty training applications/on calls/going to the pub again/wandering around London. i wonder if gnarls asked himself the same question.

to be honest i'd be useless in Africa. there aren't many skills a physician (as compared to a surgeon or an anaethestist) could bring to a warzone or refugee camp in my opinion. "i understand that the injuries from landmines here are horrific but have y'all thought about reducing your risk of stroke with a statin?" beyond that, i don't think i'm brave enough. i'm not even brave enough to admit to myself that life is pretty shit stuck in a pathetic "at least i have enough money to live somewhere nice and go out every so often and take a holiday twice a year" existence. there must be something more. whoa. it always comes back to MY problems.

anyway Ms D&C and I bid him farewell on Sunday evening. i'm not sure that i'll see him before he disappears off to foreign plains and new adventures. so, if you happen to chance upon this, here's to you Gnarls Barkley. look after yourself, stay safe, and next time you pass through London there'll be an empty bar stool and a Staropramen waiting for you.

[i am listening to Nothing To Say (and i don't actually) by The Strokes. still no exam results. although having just read what i've written i'm past the point of caring at the moment.]

[if you haven't already heard, the shiny happy person has returned]

one-way or return?

"from 19 November if you don’t touch in and touch out you will pay a maximum cash fare for your Tube/DLR journey"

...as you may have heard/read on the radio/paper in the last few weeks. the oyster card for those non-londoners reading is a credit card sized ticket onto which one can buy tube/bus tickets. the option also exists to load a preassigned amount of money onto the card so that each time it is touched on the yellow disks above at ticket barriers the travel fee is automatically deducted from the card.

anyway it was with the above warning in mind that Ms D&C and I descended into the depths of the underground on Saturday night.

a bit of background: she'd just finished a fourteen hour shift and i had of course been bumming around at home. a good friend of hers was having a house party in islington and given that poor Ms D&C was so tired by halfway through the shift our initial plan had been to stay in, put on the Shrek soundtrack, eat some cereal, dance in our pyjamas - you know the usual saturday night stuff that everyone does.

however on her way home she had a change of heart, decided that if all we did was go to work and sit at home that would make us very very boring indeed. so at about ten thirty we were all set to head off. the bus was going to take five million years and it was icy so we made the executive decision to head on the tube.

crate of beers in my arms and bottles of wine in hers we switched at oxford circus to get onto the victoria line to highbury and islington. i powered through the crowds to cross platforms. i saw an opening in the throng and nearly made it through when a hand pulled me back. i turned around to see Ms D&C gesturing with some import at the ground.

a man in his 70s lay there. let's say he wasn't looking too well. blue in the face, not breathing. this is generally a pretty bad thing. people were standing around but not doing a great deal. so we started CPR.

after three rounds we weren't getting anywhere. still no pulse, still not breathing. the staff were clearing the station and then one of the ticket people ran back with a defibrillator. first aiders will tell you that the whole point of CPR is a holding measure until the heart can be restarted with electricity. sure enough after the first shock, his pulse came back and he started breathing. we waited for the ambulance.

his pulse started to get more thready and weak and then it disappeared. he was shocked again and then did two more rounds of CPR and during the third he came back. by this point the paramedics had just come round the corner and we proceeded to load him onto the stretcher.

it was that night i realised that the only way out of underground stations is the escalator. there are no emergency lifts. this man was quite heavy what with the oxygen and everything so eight of us had to carry him on the stretcher up those huge escalators to the ambulance waiting opposite topshop. i kept glancing at the heart rhythm which before the second shock had looked like supraventricular tachycardia (a very fast heart beat) but was now sinus tachycardia (a more stable heart rhythm) so was slightly more relaxed.

as we rounded the ticket barriers with this man on the stretched neither myself nor Ms D&C validated our oyster cards.

he disappeared with his wife and the ambulance crew into the night and we decided to give up on the tube for the evening and a taxi whisked us across town for beers and mulled wine.

the next morning we decided to call transport for london to explain why we hadn't touched out at the ticket barrier in the hope of not being charged 30 quid or whatever. i went through where we had got on the tube in excruciating detail and then described exactly what had happened on the platform to the guy on the helpline. the last part of the conversation went something like this.

"so this man had fallen down?"

"well kind of. he fell down because his heart had stopped."

"so he had a heart attack?"

"he had a big bypass surgery scar on his chest so that's a possibility."

"and you helped him upstairs?"

"well kind of. it was more we were trying to get his heart started."

"and why were you unable to validate your oyster card?"

"there was eight of carrying him on stretcher. i had no hands free. i think we were all quite worried and concentrating on getting him safely out of the station into the ambulance. going back through the barriers to touch out wasn't really a priority"

"ok sir. i'll refund you this time but may i remind you that from 19 November if you don’t touch in and touch out you will pay a maximum cash fare for your Tube/DLR journey and i won't be so lenient."

__________________________________

[the brian jonestown massacre were superb. a really really tight band. anton newcombe remains as narcissistic, self absorbed, talented, and messed up as ten years ago. i never know what to make of him. i flit between thinking he's a total wanker and then filled with awe and admiration. he spent five minutes having a go at a heckler. hilarious. joel gion seemed oddly mute though.]

__________________________________

i found out today that the man from saturday night survived and is doing well in hospital. i'm relieved and pleased for him. i might look at work slightly differently today. maybe it's not all so bad.

fight on stage

*ssshwooop* there it goes

another friday night disappears. and guess what i was doing. not out. not with people i love (well not till the dying hours.) not relaxing. not even on call. but yes i was at the hospital.

we have a ninety year old. he's a bit fragile. he hasn't been able to eat anything for a month because a peculiarity in the anatomy of his oesophagus (food tube from mouth to stomach) means that food isn't going down.

as a result the protein levels in his blood are very very low. as a result of that any fluid that goes into him as drips doesn't stay in his blood vessels but pours out into his arms legs abdomen lungs etc. similarly not a lot of blood is going to his kidneys and they are failing.

i had to put a large drip into one of the big vessels going into his heart on tuesday night (after work) because he was too swollen to get a normal drip line in anywhere else. however despite this the only way to get him any better is to get the protein levels up in his body and the only way to do this is to feed him. however every effort to get a feeding tube of some kind into him is failing.

he has one last chance. one of the clever radiology doctors (a top bloke as it happens) reckons that he can get a feeding tube into this man. this is scheduled for monday morning. in the meantime my patient continues to deteriorate.

there are lots of ethical questions. "did you say 90 dr D&C? have you gone out of your handsome little head?" how much should you do for someone so elderly and so fragile? there have been many occasions (see lady in last post) where we've pulled out. my man, despite his body being so weak, is completely with it. i've had about four or five chats with him along the lines of "how much do you want us to do?" and each time he says he says he's "quite up for a go with the tube through the nose."

we don't think that he's confused or lacks "capacity" and so our options are to give any therapeutic options a go (provided they don't harm him any more) or... well... to let him starve. the team sat down and had a bit of a discussion about this. despite my harsh impenetrable exterior, i found myself advocating for the "we've got to give him a chance" approach.

the problem then arose (on friday at 3pm as always) that we have to keep him going through the weekend. it could be argued that if he hasn't fed for so long is another two days going to make a difference. i always feel that if you make a plan to pursue a certain management plan, you do it completely, without fudging, and properly. so in order to get some protein into him we organised intravenous nutrition for him.

to provide this, my man needed ANOTHER big drip going into his heart. i elected to stay back after work with one of the other doctors to put this in, partly because i have more experience.

it was bloody hard. i haven't failed getting one in for a long long time but for whatever reason, it didn't work. my colleague had a go but also couldn't get it. i tried again. no joy. at times like this the anaesthetists are the people to call on and sure enough we did. by this time it was 830pm. i sent the other doctor home because 1) it's courteous to wait around for your help to thank them and explain the situation and 2) there was no point two of us being there.

the anaesthetist failed three times. finally at about 930pm it went in. my man started his feed.

by the time i got home it was late, i was exhausted and not even a cheese and tomato toastie could save me. not even johnny depp's peculiar cockney accent in From Hell either.

i'm not sure what i'm moaning about really. i'm not too fussed about failing the procedure as it clearly was a tricky one. i don't know if it's about staying late either. i suppose it's more that some of the doctors in this system actually do give a shit. i just don't think that managers/royal colleges/the daily mail/the department of health really care. management would have had a go at us for staying so long after our end of shift. they would have said we should have handed this all over to the night team. you can't just dump complicated situations like this on other people. maybe i'm trying to convince myself that i'm still a "nice person" and have some humanity left in me.

the flip side of this i'm starting to wonder why i bother. if/when i fail this exam in a few weeks time i'll think what is the fucking point? there are hardly any jobs available for february. if i'm unemployed then i'll also think what is the fucking point? if the change in training screws me over i shall also wonder what is the fucking point?

i guess if it give this guy a chance to get better then there's my answer. but, in the scheme of all the other crap in the NHS, i don't know how long "finding happiness in helping people" will keep me going.

_____________________

on a lighter/darker note, i did laugh to myself when i checked the sitemeter the other day and realised that most visitors to MOADD arrive by a Google search for "i hate medicine."

[i am off to see the brian jonestown massacre on sunday night. here's hoping for a fight.]

this is what happens when you fuck a stranger in the ass

not pleased.

friday night. the registrar informs me and the house officers that a hand in clinic is required on monday morning as the boss is away on leave. no problem i say, i'll give you a hand. the house officers are both here on the ward. they can kick things off in the morning, see the patients themselves, make some management plans etc etc. then i'll pop back after clinic, get the lowdown, see a few choice cuts, go to lunch and then grab the registrar for the afternoon to go through any issues. i can then nip off to do the third year medical student teaching i've been roped into and pop back for four thirty to tie up any problems. "it'll be great for the house officers" i say. "good practice and character building for the future... especially given that we'll be nearby, only a pager away."

fine? the best laid plans?

like fuck no.

neither house officer showed up for work. convenient annual leave day and A&E shift respectively, conveniently NOT mentioned last friday.

result. just got home, patients not properly seen, hurried teaching session, shitty care, and apologies all round.

i am FUCKING LIVID.

[i am listening to sufjan stevens in an effort to calm me down]

dreaming of you

i heard on the news that captain nob cheese himself pete doherty, the talentless gomer of the libertines inexplicably fawned over by indie kids all over, is releasing a clothing label. i presume this is because he has realised that he is a waste of space whose time in music is near over and soon his name will be less than a whisper in the abyss of lost z-list celebrities.

it was also good timing that i caught Calexico at the Camden Roundhouse this weekend. here are a band that have stayed pretty much off the mainstream (not sure why) but still have a strong following. needless to say they were brilliant. they are also such a bunch of chilled out guys (or so they seem) on stage and bloody talented musicians, each playing a couple of instruments. one of the guys (in the back, second left in the picture) is a superb guitarist/slide guitarist. he wandered onto stage with his funny glasses and his exceptionally non trendy shirt, waved once or twice to the audience and then blew us away with his music. at the end he waved again and toddled offstage with the rest of the band.

what a great life. he doesn't feel the need to have to impress by getting himself into the tabloids wasted on coke. he wakes up in the morning, puts on his geeky shirt and then goes off and plays his guitar. straight down the line. and people love him for it. a simple existence.

(he may be a total cock who beats his wife but go with me on this)

oh for the simplicity of it all! it's so simple it's elegant.

oh for a simple life.

the lady mentioned before passed away on sunday.
[i am listening to nina simone]

burning bright

i have increasingly found myself adopting something of a clockwatcher attitude to work and also conveying my ethos to the new junior doctors. part of this is because our bosses badger us to make sure we leave on time for fear of reprimand by the government. more, it is because the NHS is such a miserable place to work these days.

to be honest, apart from staying to help the person that becomes acutely unwell at 4.50pm, why would anyone want to stay a minute longer than they have to in the dirty wards, in the company of disinterested staff, performing eight contrived tasks to attain one simple goal?

"thankless" is the wrong word to describe my job for it suggests that i want some kind of kudos, some kind of appreciation, above and beyond my paycheque, for what i do. wrong. i don't want hordes of patients throwing themselves at my feet in gratitude, pawing at my converse hightops, shedding tears of euphoria. "halleluia we have been SAVED."

all i want is not to feel that i am constantly fighting against the system in order to make it work. everyday involves pushing and pushing and pushing to get things done. i feel like a shaven Samson (after a bit of how's your father with Delilah) trying to topple the pillars in the temple. only there is no divine intervention from God. because God has been replaced in the NHS by a protocol driven 4 hour maximum entry pathway into the kingdom of heaven and because divine intervention is not a part of Hospital At Night as it is provided as cross cover by the ENT registrar on call from home. is it a massive demand to want everything to flow a bit more easily, so that we can sit in a coracle and paddle calmly down the hospital river and out into the sea of good patient care without hitting big fuck off rocks.

but back to clockwatching. despite all my efforts, tonight i find myself returning home five hours after i should have. "why Dr D&C?" you lament. "surely you must have been on the beers?" no. i shake my head.

there is a lady who is dying on one of the wards. she was brought to hospital on death's door, nay, looking through death's letterbox asking if anyone was home. she has had a big stroke and her body is also riddled with infection. the bacteria have formed colonies on the valves of her heart and with each contraction of the heart little pieces of these colonies fly off into the blood stream and seed her lungs, her skin and her brain. she has been treated aggressively, perhaps out of scale with her pre admission quality of life (largely chairbound, her family doing EVERYTHING for her) but over the past few days it's been clear that we aren't winning and she is slipping away.

it has fallen to me to speak to the family to tell them what's going on. i've called them several times each day but no response on their home phone. hardly surprising: the patient's daughter has four kids to school and work at the same time. anyway it gets to today - friday. again no response from the daughter's house but the nursing staff inform me that she did pop in at four and would be coming back later in the evening.

the daughter is an intelligent worldly woman and she doesn't need to be a doctor to know that her mother is dying. she knows this and i know that she knows this from talking to her before. i could have just left it, packed my bags at five and taken off. the nurses could tell her that things weren't looking good and that her mum might die this weekend. and when her mum does die the nurses could also tell her that it was to be expected and she would probably have known that too.

but i couldn't just leave it like that. nor could i do it all over a five minute phone call. i wanted to see her again in person and talk to her.

i waited till she came back from picking her daughter up at 8pm, made her a tea and sat down with her. as i expected, she already knew what was going on, that her mother had not responded to treatment and was deteriorating. i told her that she would probably die in the next few days. she cried and cried and i felt like a proper cunt. i spent another half an hour talking to her about her mother, her life and her kids. she is exhausted from rushing to the hospital daily to looking after her kids and trying to work at the same time. she is in the real sense of the word remarkable. we then went to her mother's room and made sure the pillows were in the right position and that the blankets were covering her properly and that she was comfortable. i stopped all the unnecesssary medications and made sure all the drugs that she might need for pain relief, sickness, etc over the weekend were written up. i went and told the nurses three times what was going just so they wouldn't forget or fuck things up even more. i went back to the daughter, said my goodbyes and took myself off home as she cuddled her mum.

so the clockwatching didn't go to plan. and five hours later i am finally home though drained and lacking a third of the weekend. but how could i leave work tonight with a situation like that? i couldn't leave that. you would surely have to have a heart of stone and acid for blood to leave her. and besides no-one else was going to do sit down and talk to her. i wonder whether the nurses would actually do it when faced with thirty other people to look after.

i wonder if someone will do it for me or for my kids when i'm leaving this life. and when this lady dies this weekend i hope her daughter in her utter shitty grief can take maybe an atom of comfort in the knowledge that someone had the decency to tell her what was going on during her last days.

and that's the final and probably most important thing i want. i can do without making the fancy diagnoses and performing the clever surgery. i can do without the stupid exams and the teaching hospital jobs. i just want this system to have a bit of fucking decency.

MRCP PACES is one of my favourite things

the car crash that was the MRCP PACES examination is over and the charred body of Dr D&C has been pulled from the burning wreckage. "he's so young" say trenchcoated detectives surveying the scene.

it was needless to say a painful and humiliating experience. the work i'd put in for the past few months seem to head directly at high velocity down the toilet. having spent a sleepless night in a coastal guesthouse and arriving at the exam centre particularly nauseous (probably due to the earlier presentation of cereal and a full english breakfast in the hotel dining room), they proceeded to keep us waiting for an hour. nervous frivolous conversation with the other candidates was forced ("where do you work?" "is surrey nice this time of year?") interspersed with long periods of silence when all along i just wanted to scream and scream and scream whilst prising my eyeballs out with my stethoscope.

the actual exam itself was even worse. for those potential candidates out there: people who say "enjoy it" and "it goes really quickly" and "they just want to see that you'd be someone they'd want to work with as a a registrar" are talking UTTER UTTER HORSESHIT. none of the above are true. i was criticised, grilled, wrongfooted and grilled and grilled and grilled again. i could not leave the hospital quickly enough and sped back to london thoroughly depressed.

and i am still feeling pretty shit about it. like i said before i worked really hard, it didn't show and i can't bear to do it again. and i am forced to relive it regularly at work with everyone who keeps asking me what cases i got.

on the plus side i am free now for at least for a month and a bit. i have been drinking every night (recreation and not always to drown sorrows) catching up with people i haven't seen for ages, reading normal nonmedical books, going to the theatre, i caught the david hockney exhibition at the national portrait gallery at the weekend, been cooking, and have LOTS of gigs lined up.

i am also seriously thinking about quitting when it gets to august. i've seen a few postgrad courses in nonmedical things that i'd like to do. i think if i don't do this now i never will. the problems of financing and living in the extravagant way i have become used to rear their heads.

i've realised that friends/colleagues who say they feel the same way about medicine as i do, don't actually do so. i don't think anyone i know will actually leave medicine despite what they say; in fact i think they are all planning the furthering of their careers despite their apparent misery.

this makes me feel very lonely.

and scared.

[i am listening to Saint Simon by the Shins]

beer anyone?

no, this does not refer to the blanket text message i normally send out to most of my mobile phone's address book on a miserable sunday night.

actually i thought i'd mention about the gazumping of music venues by Carling in this sometimes fair city.

whilst Dr D&C has been getting the academic shit kicked out of him at various practice sessions/courses for the stupid exam this friday, Miss D&C has been having a jolly old time.

last night she and three of her friends went to the XFm "big night out". Xfm for the non-Londoners among you is one of the indie/alternative radio stations here and despite being owned by the heinous Capital FM is relatively sound in its playlist. notably it doesn't play exclusively to the student population as Radio One (BBC) seems to do, and it has the brilliant Adam & Joe on Saturdays.

anyways the line-up was supposedly quite good with the Fratellis playing and being held at Brixton Academy (one of the more cavernous venues in the city) the potential was there for some good music and a decent opportunity for some good ol' like mama used t'make indie clubbing action.

Miss D&C was however sorely disappointed.

for starters the three promised dancefloors turned out to be the main auditorium and then two corridors. not quite three dancefloors.

secondly it was HEAVING and she and her friends were faced with hour long waits at the bar. like Dr D&C, she likes a tipple so i sympathise.

but worst of all was the pricing. many of the music venues in london and increasing throughout the country are being bought out by big conglomerates. Carling, them of the beer fame, now own the Brixton Academy, or to give it's proper name the Carling Academy - Brixton, and as a result the five beers you can buy at any of their venues are Carling, Carling, Carling, Carling and Carling Extra Cold.

Miss D&C and entourage had partially been enticed to pay the fifteen quid cover by the lure of 1.90 pints. oh the upset when they realised that this was only the case at one of the bars, and that the other bars in the venue ie. the emptier ones charged the same beer at just shy of four quid.

"outrageous!" i cried. an indictment of the franchising at the expense of music. what next? see Foo Fighters at the KFC Empire Shepherds Bush? don't miss Primal Scream, headlining the Primark Koko, Camden? shame on you XFm for cashing in. but then as i said, they are owned by Capital Radio.

anyways, tonight this lost doctor is sitting in a "luxury" room in a seaside town hotel as he awaits his membership of the royal college of ingrates exam tomorrow. a listless sleep i think. i have spent the past month and a bit buried in tomes and examining as many patients as possible. my brain feels like it's going to burst. i don't know if i'll be successful this time. all i know i'll give it my best shot and to be fair i've spent a lot more time preparing for this exam than any other.

as of course dear readers i shall let you know how it goes. in the meantime it is time for some slumber, listening to the dirty sea lapping against the rubbish-strewn essex coastline.

MOADD is one today!

yes it is the first birthday of this blog and boy it is a happy day. the sun is shining and the intermittently good people of london are going about their business. i am not at work this morning either for i am currently in the second of two weeks of study leave.

on the 20th of this month i shall be sitting the practical assessment of clinical examination skills or PACES which is the last examination for membership of the royal college of physicians, the arcane body that we must all seek to penetrate if we are to progress in our miserable careers. as always it is a ridiculously expensive, soul destroying affair and i for one cannot wait for it to be over.

i spent a ridiculous amount of money on a course this weekend. it was very good but although i learnt a lot, the consistent grilling that i received from the examiners has torn a new arsehole in me. pictures some other time.

otherwise what has changed in this year of MOADD. well the bookshelves are still up. i have had a few great holidays. i have had a lot of boozy nights. i am still very disheartened in my job.

i have come to the (massive) revelation that it is not necessarily medicine but the NHS and healthcare in the UK that is upsetting me so. perhaps a move is on the cards?

whatever happens i have decided that if i pass this exam i shall resign my job and chill out for a few months. and yah boo sucks too the consequences.

of course the "if i pass" is a mountain of a proviso.

[i am listening to The Coral, Dreaming Of You]

yee-ahhh, yah, yahhhhh: the best fight scene ever

i promise that this posting of videos is just a fad but i thought that maybe you should have a look at this excellent piece of hand-to-hand fighting choreography. it is classic for a number of reasons. there are several things about it which are absolutely bizarre:

why is he in a white coat at the beginning?
where are they?
why do they take their tops off?
where did she come from? is her stunt double a man (is she a man)?
how did she break her arm?
what purpose did that bedsheet in the bucket serve ordinarily?

i'm unsure as to what film this is so if anyone knows please tell (i think it may be one of almodovar's)

vegas this one is largely for you.



PS. given that i am currently studying for the royal college of wankers examination part 3 i also feel as though i should be removing my eyeballs. "yeah! see ya!"

[i am listening to cut the f*** up]

lost doctor in holiday shocker

i shall be leaving these shores for a bit of a break tomorrow. Miss D&C and i shall be drinking the finest croatian champagne and sitting on the beach for the next week

in the meantime i leave you with two links

the first shows what a "grrreat" country i live in. i particularly enjoyed the mass rape catalogue (have a look) - the authors of this site are clearly in the parlance of our times a bunch of utter fucks

i am an englishman

secondly and much more fun and a work of SHEER UTTER GENIUS is the latest video from OK Go! who you might remember from their single Get Over It a few years ago. who would have thought treadmills could be so good.

watch this and enjoy!

see you in a week



[I am listening to Ok Go! of course]

miserable sullen bastards

regular readers of MOADD (all 4 of them) will probably have realised that the lost doctor is not always the happiest of bunnies with stethoscopes (possible playboy shoot).

this is generally due to the fact that the NHS is actively and passively raping him day in day out. it would not be a huge generalisation to suggest that this motif of melancholy courses through most of the UK doctors' blogs listed to the side (except the venial sinner perhaps as he is too often loaded or in lurve.)

the current few weeks have been particularly trying. you may well remember that august and february are seminal in the NHSian calendar because these are the times when the new blood hit the wards. the recent intake of new doctors are fucking me off.

firstly they don't do a great deal. secondly i don't think they CAN do a great deal - this is likely to be due the dumbing down of training. thirdly, 1 and 2 could be overlooked if these guys were a bit of a laugh but FUCK ME they are DULLARDS.

admittedly my two juniors are very good and fun to work with it's just that i find myself wondering around the wards keeping myself to myself in case i am trapped in a ritual seppuku inducing conversation with anyone else.

things haven't been helped by the fact that my job has changed and i have leapfrogged in on call rota back to two months ago when i was doing shitloads of nights. i feel i am being taken for the proverbial ride when it comes to night shifts.

this aggression shall not stand.

in the interim, the FISH continue to multiply. next to the fish false idol posters over the wards have appeared small whiteboards with the "attitude of the day" written on them. these are such vacuous mindsets as "fun" or "thoughtful" or "happy" for example. the management haven't thought about asking me to suggest the attitude for the day yet probably because they understand that "fuck your mother" is not the best way to engender a culture of teamworking.


[i am listening to The Concretes]

lost doctor in internet voyeur shock

as gary oldman once said, "i am very disappointed."

i have shed the shackles of this profession in the past few days and have been out drinking and clubbing for not just one but two weeks (count 'em) in a row.

i have been, to say the least, very pleased with myself.

until i realised that the photographer supposedly taking random shots at the last club i was at had actually decided to snap my normally beautiful face in the most awkward of poses and, to add insult to injury, plaster it all over the internet for all to see and point and laugh at.

you will of course appreciate the reasons for not posting a link to said picture here on MOADD.

i lament the state of the world when ordinary folks like myself should fear going out for being snapped by a wannabe paparazzo.

posh and becks: i know how you feel.

and to top this, the CANADIANS have pulled a similar stunt. they have hidden a pic on their website which is also the least flattering portrait one could imagine, emphasising an extremely tired D&C post nights attempting to non-chalantly point at the camera very casually but ultimately looking like what can only be described as a total cunt. and therefore no link shall exist to this photo either.

i can only imagine that they have done this for pure comedy reasons.

as a result the london canadian embassy 2 is closed indefinitely.

the lost doctor is very disappointed.

[the holloways are barely keeping me happy with their new single two left feet. alternatively i suggest you check out apathy using a sample from the white stripes on "it takes a seven nation army to hold me back."]

[if you haven't already bought a copy of Casa by my good buddy Roger (Dean Young and The Tin Cup|), I implore you to do so - "eez very cheeep for to do romance inside you" as Borat might say - look here]

the miscalculation

i feel a bit like denzel washington at the end of "Man on Fire" - i shall not spoil the ending but i foolishly have swapped my on call shifts with oblivion this week.

having finished my set of nights on friday morning, i now realise that i also agreed to do this weekend too. hence i have that heartsink feeling one gets when england go out on penalties (man on fire is not about on call rotas or football for your information.)

so off i am to work in half an hour. i know for a fact that NO-ONE is awake at this time on sunday morning. i also feel disconcerted because a friend of mine had a spare ticket to the Red Hot Chili Peppers last night. i keep telling my self that i don't actually like them (release the same song over and over, never topped 1991's Blood Sugar Sex Magik, etc) but it would have been good to see my buddy with whom i spent three months touring the world a few years back.

i am going to have my breakfast and think about the milk situation at work.

[i am listening to Oh Inverted World, the first album by the Shins who i keep missing each time they play the UK because of surprise surprise work]

the memory of milk

this is the door to the fridge in the doctors mess.

each of the bottles has about 30mL of milk left in the bottom. there are about 15 full unopened bottles in the fridge itself.

people do not finish the bottles. some unspoken fear of drinking the milk at bottom of the bottles prevents them from doing so. they replace the bottles in the door and open a new one, which, in time, also joins the graveyard of nearly finished bottles. the milk remnants are perfectly drinkable and at the correct temperature (cold).

no one speaks of this. lips remain tightly shut, heads turn away. it is the way it has always been and it is the way it shall always be.

what has happened here? who is controlling this?

it puzzles and concerns me. we are NOT who we appear to be.

i glance around furtively in fear that i may at any moment be hoisted into a massive NHS wicker man.

[i am listening to Eleanor Put Your Boots On by Franz Ferdinand]

in other news

i have forgotten to mention that the venial sinner is actually working side by side with me on the wards at the moment. i had not expected his smug face to pass my field of vision in working hours so was surprised to see him rock up to FISH ward 1 looking scared and lost last wednesday.

i am hoping the travails of day to day work will be made easier by the presence of a co-worker who will never say no to cheeky coffee and post 5pm beers.

what japes there shall be! what tricks we will pull! bloods will remain undrawn! investigations will be unordered! results will not be filed! patients will have rasberries blown in their faces! professors shall be mooned as consultants are wedgied! and then together we shall skip merrily down the corridors to medical anarchy. viva la revolution.

when i get back from nights of course.

[i am listening to Hot Fuss by the Killers. dare i say not as good as when it first came out?]

fully operational battle station

i feel i've made a little headway to finding the answers (or at least some of them) to the questions i first posed when i started this 'blog. this has to some extent been consolidated by a long conversation i had with the bishop (himself about to enter into the medical world) on friday night, fuelled by beer in a pub that used to have a bare knuckle boxing ring upstairs.

it is obvious that some things will never change. at least i have a bit of an idea as to what those things are.

a lot of what lies ahead is worrying, some is exciting, some is going to be a fucking nightmare.

still at least i have had the sun in london to help me with my thinking.

a week of nights awaits but i'm actually looking forward to a big breakfast tomorrow.

my foot in green park earlier this evening

[i am listening (and watching) the world cup final live on the internet - thank you the BBC]

as a reminder

i was walking down the stairs to the "mess" (the room that we doctors spend a tenner a month funding so that it acts as a safe haven away from the barking commands of other healthcare professionals) when i noticed this new sign. i broke out in hysterical laughter which then descended into crying and wailing. to top things off my purchased sodexho sandwich disintegrated in my hands moments later "salmon and dill" all over the floor.


[i am listening to regina spektor - buy her new album! it's great! and she seems a bit nuts in a tori amos way]

no expense spared

in these times of massive NHS deficit, you will be pleased to hear that my trust has been investing its elusive budget in worthwhile projects.

last week the following appeared on several wards:

they gradually multiplied in number to the point where most of the medical wards were covered in them.

plastered on the patient board, on the doors to the staff rooms, over the treatment room, etc

what are they? i asked around.

the doctors certainly didn't know. the ward clerk muttered something about management.

the nurses all smiled cheekily and said they couldn't tell me.

the senior nurses/matron all gleefully said "ah ha - you'll find out next week."

i did wonder whether i had wandered into john malkovich's head or perhaps the deck of the marie celeste but instead chose to try and get on with my job as reality decayed around me. i kept glancing around to see if ALF was going to appear.

anyway, so this week i stumbled into the staff room on one of the wards to see the table cleared away and lots of different coloured card, glitter, glue and felt tips replacing the usual array of rotas and handover sheets. using these tools were several hypnotically happy members of the nursing staff engaged in the making of cardboard fish and adding them to a big wall display of more fish where the noticeboard used to be.

yee gads i thought. has everyone been hit by some childhood regression alien virus? has some devilish pied piper character drawn everyone into some sort of strange cult of collage? have people been drinking the hospital Sodexho tap water again?

i still couldn't get a straight answer out of anyone through their glazed, pritt-stick covered eyes and then saw a poster (replacing the antibiotic guidance one) referring to the fish philosophy.

"for Crippen's sake, what the fuck is the fish philosophy?" you may ask, as i did as i negotiated my way through the sea of crayons.

well i suggest you check out the website. (please please have sound enabled)

once you have finished chucking out your guts in laughter/nausea pinch yourself and ask whether the world has truly gone completely nuts.

as far as i am aware, under the fish scheme staff get a "fish" for doing something "great" and once they accumulate 5 fishes they get a free cup of rancid Sodexho coffee.

i don't know how fish define something great. maybe it's... let's see... something to do with doing your job?

this is worrying for two reasons; firstly that nursing morale is so goddamn low on the medical wards (the nurses there are by and large very good but VASTLY overstretched and under supported) that they need some crazy scheme to reassure them that they're doing something worthwhile.

secondly it suggests that someone actually thought this was a grrr-eat idea and was swayed by some tosser in a lime green shirt. i dread to think how much this has cost and how many prostitutes lime green man has indulged himself with for that sum.

am i being harsh? am i completely out of touch with modern management techniques?

or do you also think this smells of horseshit? surely this is not the way to re-inspire a workforce.

i am, as always, open to the view of the blog panel.

in the interim i am not making any fucking fish.

[i am listening to Creedence Clearwater Revival - Lookin' out my back door]
[DISCLAIMER: this does not represent the views of my NHS trust... oh dear, i may get fired]

why so mean?

so ok i'm not hitting the 30 days. but then i realised visiting the site that several infinitely more talented people are producing real works rather than babbling on a blog.

i am currently a bit dazed. i have just returned from the Ritzy having seen Paul Greengrass' United 93. i'm not quite sure how i feel about the film. i shall have to sleep on it. certainly there was no ben affleck to save the day. very harrowing.

the canadian embassy has closed down for a few days so i am back in my home. it has been a wonderful weekend, partly because the sun has allowed for lazing with the papers and picnic food in the park.

i also went to the wedding of a friend from med school on saturday night. a great day and a chance to catch up with old buddies. a bit nostalgic really. the best man was talking about our first year and all the hilarious shenanigans in residences. everyone was smiling and laughing but 8 years older and i (one of the few who isn't married or a homeowner) couldn't help wishing for happier, simpler, less responsible times. ah! the wonders of ageing.

roll on 30.

[i am listening to the rapture]

Gah!

i have failed at the first hurdle with regard to the 30 days project.

there are several reasons for this - there are always reasons.

i have firstly been trapped in bed feverish for the past two days. a bit of a cold or perhaps the imminent HIV seroconversion illness. i'm not sure.

secondly i am not even at my flat! once again my canadian outreach project has meant i am putting up the mum of one of my friends. decamping at my special lady's has also resulted in a disconnection from my lifeline to the internet. and as the trust won't let me connect to blogger this has lead to the fucking up of my "participation."

anyways to resolve this i shall continue for 2 days after the end of 30days to make up for dodgy circumstances.

[i am listening to the kooks]

30 days

i've decided to sign myself up to this 30 days project. this is all in an attempt to update this blog a bit more than "occasionally".

whether i succeed is another matter.

please join too fellow bloggers! prove to yourself that you are not professional procrastinators!

[i am listening to the zutons]

take your performance feedback and shove it up...

... because my good friend in wales and i have both passed our exams (membership of the royal college of physicians 2: die harder).

i was foolish enough to NOT opt for getting my marks published on the web so i had to wait till today for the stupid envelope.

anyway it is a massive relief for us both (failures the first time round) and so we are kicking back and relaxing this weekend. he is paintballing for a stag weekend and i am going bowling tonight lebowski style.

i nearly stayed in again last night but managed to pull myself off the sofa to go for a few beers with an old friend. it is tragic. i can't drink as much as i used to by any stretch of the imagination and i was almost content to veg on the sofa overnight.

but i pulled myself up and moseyed on out (well just locally) as i think if i become the sort of person who works, eats and sleeps that will be a non-existence.

i have a couple of incidents at work to report to you all. but i shall leave that for the next post as i am too excited and relieved at the moment.

sometimes you hit the bar and sometimes the bar hits you

[i am listening to Romeo and Juliet by Dire Straits]

you're a lightweight. you're fired.

dr D&C was skiving on friday.

that's not strictly true. i'm going to be unemployed in august and so i said to the house officers that i would be in at 9.30am because i wanted to hand in a job application at another hospital. i also said to them bleep me if there are any problem because yes ladies and gentlemen my pager not only works in the hospital, it also works at home, it works at my friends' houses, it probably works abroad and when i have left this corporeal existence and ascended to a higher plane of consciousness/the afterlife, i am sure that it'll still be putting through the crash calls at 3am.

anyway i left my friend the bleep/pager switched on and sure enough at about 9.15am it went off. i called the phone number displayed and to my suprise it was the voice of the clinical director that answered.

being called by the clinical director is a rarity. it is also quite frightening. you feel a bit like the generals in that scene on the death star in Star Wars when darth vader announces that the emperor will shortly be arriving. "the emperor is coming here?" reply the assembled generals, terrified faces, poop in their pants.

actually our leader is quite a nice guy. he tutored me as a student and i quite liked him. what on earth could he want though? i briefly scanned my mind of the medical activities i'd been involved in over the past few months. no, i couldn't think of any obvious malpractice.

he asked me if i had a minute. i was buying a coffee so i guess i did. he proceeded to ask me of my thoughts on a radical shake up of the way the hospital works. yes he was asking me about hospital at night.

i won't go into HaN in detail as i have ranted at length about it here. also refer to Dr Crippen for more details. in short the idea is that you only need a skeleton crew to run a hospital overnight and at the moment there are too many doctors doing far too little work.

the wonderful thing about HaN is that it is marketed (in the labour spin world) as something to help us doctors have a smoother time on call. bollocks i say! it is about cost cutting and meeting working time targets. that is what it's about.

at present in my hospital we have two junior doctors covering the wards, splitting the hospital geographically down the middle. what the clinical director was asking was why not get rid of one of the doctors and provide an advanced nurse practitioner with advanced skills (he said advanced twice) instead.

what are advanced skills? i'm not sure really.

bow hunting skills? computer hacking skills?

anyway i said i'd let him know on monday because delight of delights i was to be night shifting across the weekend. and off i scampered into work that night.

the weekend was fine as it happens. people weren't very sick and the stuff i had to do was quite basic... for me. initially i thought about writing back to mr clinical director with "bring on the nurse practitioners and screw you guys i'm going home."

but then in retrospect i thought about the activities i'd got up to overnight. for example prescribing fluids. this is relatively easy but then after three years of medicine i can very quickly assess someone's hydration status, their requirements, factor in their cardiac/renal status, correlate this with their electrolyte results and give them the right fluid at the right speed so that their organs get adequate perfusion and they don't drown in fluid. though it has taken me a long time to get to that level.

so i am a little perturbed at a nurse practitioner rocking up and ploughing 3 litres of gelofusin into a tiny man whose heart has the equivalent pumping function of a small clementine. that could be a disaster.

similarly i had lots of people with chest pain. again you have to worry about the heart. even if you take a careful history and look for (what can be subtle) changes on the ECG it can be a very difficult call. do we want nurse practitioners with no cardiac training to be doing this? i'm not sure (though having said that the CCU nurses i worked with were superb.)

anyway i sent my email back to the big boss saying that i didn't think that we were ready for this scheme. if the nurses had years of medical training and experience (ie were doctors) it would be fine. knowing my hospital they'd do it on the cheap and employ someone who was all talk and no ability.

did he reply? yes he did.

"thanks for the email. take care."

who says i don't make a difference?

[i am listening to the specials]

Escapism

a quarter of my patients have cancer of some kind.

i've spent the last few days taking them into quiet rooms, sitting them down, asking the same question over and over.

"what have you been told so far?"

they go on about how they came in with a chest infection/fluid on their lungs/etc and then i have to launch into the splendid bullshit.

"that's right. now that scan we did yesterday. well it's shown a lesion/mass/abnormality/cyst/shadow/irregular feature and we need to do a few more tests and speak to a few specialists before we can tell you exactly what it is and act accordingly."

what i want to say is that it looks, smells and tastes like cancer. you have cancer. and the pains we'll put you through to get the sample of tissue to prove this isn't going to change the fact that you have cancer.

of course we're not supposed to say that. in fact i got a telling off as a freshly qualified boy doctor for saying to a patient that although we weren't sure yet what we were concerned about was the possibility that his mass (in his pancreas) may be cancerous.

bad Dr D&C. go and kneel before the GMC with your trousers down.

don't you realise, i was told, that if you even MENTION the "C-word" then it will do more damage than the diagnosis itself.

quoi?

the word will do more damage than the cancer? somehow the word will metastasise and infiltrate all his organs? the word will cause him unbelievable pain and nausea and diabetes in a cruel twist?

no, i was told, we must wait for a tissue diagnosis.

of course said tissue sample took four weeks to get because the procedures (cameras down his to his duodenum and the probing around with a brush in various sphincter) ran into problems each time. anyway, we did finally get the biopsy, we told him he had cancer, he said he had expected that it was going to be cancer and then he died the next day.

but of course it was not the adenocarcinoma that killed him, it was the word.

anyway i must now bite my tongue. i shall wait the time it takes to get Mr K's pleural fluid back from cytology, i shall sit in patience as the lab slices through Mrs G's gastric biopsy and i shall make sure everything is ok after they've had a wash around Mr P's lungs with the bronchoscope. and then, one week on, EVEN THOUGH WE ALL KNOW NOW THESE PEOPLE HAVE CANCER, we shall tell them that they have cancer. in the meantime i shall lie every day to them, through the veil of " we need to do further tests" and "the lab is still processing the sample you poor cancer riddled bastard" before calling in the palliative care team who can start the syringe full of morphine and hasten their discharge to Rose Cottage.

excuse me, i have to go and put on my best used car dealer outfit in preparation for a day full of mendacity.

[i am listening to Primal Scream's new single. i saw this on the web today and it made me very geekily excited]

do you mind if i do a J?

now i'm never one to preach but i feel that i should for once (halleujia, y'all can be saved ma brothas and sistas.)

pete libertines doherty is in the news again this time for allegedly injecting into one of his fans/entourage/groupies. until now i haven't really given a shit about the whole junkie/kate moss bruhaha that the tabloids are so interested in because let's face it most of the country takes a drug of some kind (hash/tobacco/alcohol/ribena/religion) and most importantly because babyshambles are rubbish (NME hat on again) and, as the new dirty pretty things album demonstrates, the libertines were the sum of their parts and when separated are purely mediocre.

but it is starting to piss me off that doherty is getting off every time (and it must be about a million now) when i've worked with/treated enough addicts who've gone to jail for far longer for far less. the even more tragic thing is the misguided doherty obsessionados - you know, the ones who throng outside the courthouse - who rant on about how he is being unfairly persecuted by the police. here me now, oh deluded public school teenagers. persecuted or not, he has actually been in possession each time he's been nicked and it seems that this time he's been so off his face that he's fallen for the "someone wants to take a picture of me" trick AGAIN.

getting off drugs is difficult. i think maybe only one of the many users i've been involved with ever got close to sorting himself out. doherty has the luxury to fly off to arizona to detox at any point if he so wishes. not everyone has that. he can't be arsed and would rather be "playing" gigs wasted. i was really annoyed that the love music hate racism charity were stupid enough to put him on the bill at the trafalgar square gig this weekend. he shouldn't be championing such a cause.

anyway, he'll never get off drugs and he'll never go to jail - not to do a significant period of time like my patients - and this will be to the applause of the white, upper class kentish town teenage girls who love him so much. perhaps it was one of them that he's been photographed injecting. daddy has probably picked her up the following morning anyway. in which case should i really be getting so worked up? after all stupidity (and misery) loves company.

[i am listening to up the bracket and wondering about what might have been]

i don't want your sympathy; i just want my johnson

the surgeons managed to shit on us today. however it was not us who suffered in the end. it was the patient. who died.

i was hovering on one of the surgical wards where one of my other patients was going a bit nuts when i got a nudge from one of my house officers. he informed me that the surgeons were referring back a patient to our care (even though our boss had not been informed) and oh yes by the way his blood pressure is crashing.

i put on my stroke my beard glove and stifled my need to tell him that we should only see patients that have been officially referred to us and that he should not be accepting patients without running it by a senior. but i held my tongue and wandered over to check out what was going on.

this old man was not a very good advertisement for health (or a very good advertisement for disease depending on whether you're a half empty/full cup person) he was six days out of an operation to remove his right lower leg because of very shit blood vessels not being able to provide his limbs with enough oxygen and nutrients to stay healthy. furthermore amongst his huge list of problems, his heart beats in a rhythm called atrial fibrillation. Dr Crippen has written at length on this topic. whilst it is very common the problem with this rhythm is that blood pools in the heart, forms clots and then there is a risk that these clots fire out of the heart to other parts of the body.

well he was in shit. he had a crap blood pressure, his breathing was awful and his tummy had swollen up and was very tender to touch. he had stopped peeing and was vomiting bile. it didn't take a lot to work out that what had most likely happened was that a clot had fired off into the blood vessels supplying his bowels thereby interrupting the blood flow to his gut. his bowels were now complaining as they slowly died of no oxygen.

myself and the house officer proceeded to resuscitate the patient but the only way to treat this condition is to operate. i called down the on call surgeons, the vascular surgeons who had operated on him in the first place and the high dependency unit. i was bounced from one to the next to the next and then back again. finally after four hours the surgeons decided that they would operate but only after a CT scan.

but by then it was too late and he died.

and no-one was really bothered. no-one would take any responsibility for the patient. except for us and only because we happened to be across the corridor at the right time.

would it have been different if he had gone to HDU? maybe. but there were no beds. so he stayed in the sideroom on the ward vomiting up more and more bile.

another nice happy ending.

[i am listening to black and white by the upper room]

i like the way you do business jackie

i have finally lived a little in the last few weeks, perhaps at the most inopportune of times.

yesterday was the resit of my stupid exams, an exercise in masochism which i am convinced will need to be repeated in a few months time but hey i'm getting used to the idea that i am fundamentally stupid.

anyway much more interesting was firstly turning 27 which was not depressing at all and also my continuing canadian outreach project.

as you may have seen in a previous posting, Roger Dean Young and the Tin Cup finished their UK tour last week and i had the pleasure of three of the lads hanging out and stinking out my flat for a little while.

i met most of the guys through other Vancouverians (Vancouverites, Vancouverers?) over the past few years and have always been struck by how down to earth and well... nice they were. i guess i've spent so much time interacting with wankers that you forget that there are actually "good people" in the world. and they're in the music industry which in my experience in hobnobbing with C-list bands and sometime music journos is a vacuous self-absorbed scene indeed.

i also realised that there are so many talented people in the world that it's quite sobering when compared to your own pathetic achievements. i did find myself tinged with feelings of jealousy at one moment at the last gig. but perhaps it was the staropramen.

it's been a bit of a comedown to see the guys leave. it's difficult when you don't see people that often and your only contact is email. still i shall try to not get too depressed about that. after all that's what postgrad exams are for.

so a year older and a year stupider. i shall now enjoy the holiday weekend (not working) and hell maybe i'll dust down my guitar too.

happy easter

PS. roger was quite troubled by the ALF dream. unfortunately he didn't have any deep meaningful thoughts on the underlying symbology much like everyone else. i'm still waiting.

PPS. i would also like to announce the maiden voyage of my second blog: The Chelsea Rebel. no medicine and a slightly different background to MOADD. please also note the radically different layout.

[i am listening to the Foo Fighters]

never ceases to amaze

i'm currently entrenched in a set of nights. now that i have transferred to the wonderful world of general internal medicine from renal, the night shifts involved covering A&E which is fine. it's probably the best bit about hospital medicine when you're a junior; you're given the opportunity to see a patient from scratch and try and work out what's wrong with them. proper medicine. no wheeling patients round to X-Ray because no-one else can be fucked too. A&E is generally pretty well organised.

you also carry the "crash" bleep. if someone anywhere in the hospital stops breathing/heart stops the staff on the ward (hopefully) notice, send out an emergency "crash call" and a group of doctors/nurses (normally two doctors, anaesthetist plus others) immediately proceed to the patient who is dying.

so this morning at about 1am, sure enough a crash call comes through directing all and sundry to one of the elderly care wards. having got a good sprint on me i arrive first. there she lies, Mrs X, in her bed, mouth open, pale as someone who's obviously dead for some time. one nurse is doing some half hearted chest compressions, another is fiddling with the defibrillator (the thing that "shocks" people "back to life" on ER) and the doctor looking after the ward is puttin the defibrillator pads on the patient.

"hi," i say "what's happened?" as i take the defib pads off and put them in the correct place on the patient's chest.

silence.

thinking i'm obviously speaking too quietly "can someone tell me what's happened?"

silence. i try to locate a pulse as the defib machine tracing shows that the lady has no heart activity at all.

"that's asystole. continue CPR. does anyone here know anything about the patient?"

"i'm just doing chest compressions" says one of the nurses as i hear the lady's ribs crack.

"get Sharon!" shouts the other one.

i turn to the doctor."are you looking after this lady?" he nods and says nothing. i feel that what should be a very quick and slick resuscitation is going to be painfully slow.

Sharon, one of the other nurses, arrives and informs me that the lady was "fine" an hour ago. given that she is an icicle i stroke my chin.

anyway by the time the anaesthetist has arrived the lady has made no progress at all, she is not breathing, her heart is not pumping and no amount of adrenaline is going to make a difference. after 15 minutes and more rib breaking, we stop.

and that was that. may she rest in peace.

i wonder when i have a cardiac arrest in some horrific hospital somewhere will people be standing around saying "i wasn't looking after D&C" or "he was fine an hour ago" or will i be so dead by the time people realise that something is amiss that it won't matter.

the venial sinner has written in his last blog entry about the transiency of human existence and whether once we leave this world will any imprint of our existence be left? if that's not something to wonder about as you stare forlornly into your pint glass, then the prospect that the actual moment of your death might be so undignified certainly is worth buying a double shot over.

[i am listening to Train In Vain by The Clash]

wait till you try the pina coladas

as part of my ongoing Canadian Outreach Project, please go and see some buddies of mine on their UK tour this week. i shall of course be plying them with beer (and certainly not lamenting the state of UK healthcare) at their London gig which also happens to coincide with my birthday hurrah.

highly recommended (and i'm not just saying that as they're mates) - there's some tracks on the links below

Roger Dean Young & The Tin Cup
website
Loose records - UK label
Copperspine records

Thursday March 23rd 2006
Brighton, England
Hanbury Ballroom
Phone 01273 325440 for more information

Friday March 24th 2006
Leighton Buzzard, England
The Wheatsheaf
Phone 01525 374611 for more information
www.thewheatie.co.uk

Saturday 25th March 2006
GLASGOW - King Tuts Wah Wah Hut
(08701 690100)

Sunday 26th March 2006
ABERDEEN - The Lemon Tree
(01224 642230)

Monday 27th March 2006
LEEDS - The (New) Roscoe
(0113 246 0778/www.liveinleeds.com/newroscoe.htm)

Tuesday 28th March 2006
NOTTINGHAM - The Maze (Forest Tavern)
(0115 947 5650)

Wednesday 29th March 2006
LEICESTER - The Musician
(0116 283 5533)

Thursday 30th March 2006
LONDON - The Borderline
(0870 0603777)

[i am listening to the Dresden Dolls]

sycophant corner

i thought i would move onwards from my surreal dream-states to a new segment on MOADD - the sycophant corner.

in today's episode i would like to put forward Kirsty Lloyd, chair of the British Medical Association's Medical Student Committee. her job, which i'm sure ensures her a fountain of tea and cakes when she visits the BMA head office, is to be the public face of the thousands of medical students in this country, bringing key issues that affect her colleagues into the limelight.

now to be honest medical students have never had that much to moan about really. until now. at a time when 80+ senior consultants in this country and over 1000 students are protesting about the changes in the way in which candidates are selected for their first medical jobs she has chosen to abandon the undergraduates she represents and instead has openly defended the ridiculous selection criteria/process that her colleagues are publicly rejecting.

i cannot fathom why. i can only assume she is suffering from a severe strain of sycophancy whereby, terrified by the prospect of speaking out, doing her job, representing her fellow students and looking like a "troublemaker", she is under the delusion that by being a sell-out and condemning her peers to a job selection system that is Paddington Bear-ian in its incompetency she will somehow further her career in the future.

little does she realise the system that she is defending will also be the same system that ensures that she winds up without a job anyway. in which case her political fellatio will have been to no avail.

Kirsty Lloyd - Featured Sycophant,
MOADD Sycophant Corner, March 2006

for the record i have no problem with Paddington Bear. in fact i am rather fond of him and have been since childhood. i have no doubt that he would in fact to a better job than Ms Lloyd and i will be the first to suggest him as the next chairbear of the medical student committee . he might, as always happens to him, fail in his ultimate goals but at least he'd TRY TO DO WHAT WAS RIGHT FOR EVERYONE and not himself. go paddington.



[i am listening to Iggy Pop]

the decay of my reality

i thought i'd break off from MMC-bashing today and tell you of a dream that i had the other day.

i was john lennon, living in the present day and obviously not shot in New York. i was out somewhere with paul mcartney. i don't remember what we were talking about. anyway it transpires myself, paul, ringo and george (yes all the beatles are alive in my dream) live together in a big mansion somewhere.

anyway paul gets a call on his mobile. "oh god" he says and hangs up. he turns to me and says "something awful has happened" and rushes to the car (i forget what kind.) i'm running behind him. "what is it? what is it?" i say but macca doesn't respond.

we get in the car and speed back to our mansion. it is huge set in beautiful grounds with a long gravel drive. we park at the end of the drive and run up to the front door. i can see a figure lying on the steps, bleeding. it is one of our security guards. he is dead.

the front door is ajar and we burst through, down the long hall. two more security guards lie on the ground. they have been shot. they are also dead.

we do not stop but rush past them to the door at the end of the hall leading to the kitchen. it is a room with a central worktop and cooker. units and appliances line the three walls in front of us. one of the breakfast stools has fallen over. george harrison lies on the floor. he has been shot in the chest. bleeding. my heart is in my mouth. he too is dead. what has happened here?

i hear a moan coming from the other side of the cooker/worktop. macca cradles george's head and sobs. another moan. i move round the worktop.

half on the floor, half propped against a cupboard, bleeding from a gunshot wound to his leg is ALF.


i remember we also share a house with the cuddly Alien Life Form from the eponymous 80s US sitcom.

"John, dude. i'm so sorry..." he says.
"oh alf. what happened..."
"i... i don't know... it was so fast. they shot george. there was.. nothing... nothing i could do."
"i know alf. it's not your fault."

and then i woke up.

what the hell does it mean? from where exactly in the recessess of my brain has ALF emerged from? i did have this dream whilst on holiday in stockholm a few weeks back with Vegas. perhaps he has been spiking my drinks? how fucked up am i? why can't i have normal dreams?

anyways. your thoughts are welcome as always. i'm off to get my depot risperidone injection.

[i am listening to Moby]

Modernising Medical Careers: An Update

the shit that is MMC has apparently hit the fan.

you all probably remember me going on about this ad nauseum in previous posts. as a quick summary, this "modernisation of medical careers" came into full effect in august last year.

the official line is that the current system of training for newly qualified doctors is convoluted, overly selective, biased and too old school. hence MMC has restructured the entire post-qualification career progression for the benefit of doctors and their patients. the new structure will speed up the training of doctors to consultant level.

before (or "in my day") doctors would secure jobs on the basis of their performance at medical school in written and clinical examinations and the strength and breadth of their CV coupled with the impression they gave at interview. this is not dissimilar to, well, ANY profession.

now however, final year medical students/newly qualified doctors do not do this. instead they have to fill in a form.

this form consists of 6 sections.

• Academic Achievements,
• Non-academic Achievements,
• Reasons for applying for a post,
• Good Medical Practice,
• Teamwork,
• Leadership

the applicant has to write a 75 word piece on each of these sections extolling their virtues. no more interview. also, each of these sections are equally weighted. so, academic achievements takes the same priority as non-academic and leadership.

this is a bit mad newly qualified doctors rarely need to take a leadership role, not on a regular basis anyway. and yes i would certainly prefer to work with a music afficianado but would be seriously pissed off if he/she could cite the back catalogue of Wilco but was unable to examine someone's chest.

unsurprisingly, medical students are unhappy. one of the reasons is that this application is a bullshitter's dream. you could write anything you wanted and because it is being marked without interview no one would ever know that, despite having put down that you were captain of the uni football team, you have no idea what a striker is and it doesn't matter because you will never ever be asked.

you can read more here about this mess and if so inclined sign a petition put together by disheartened medical students. i really feel for them. having worked so hard for the past five years they have been told that actually maybe they should have spent more time looking at ways to demonstrate their team work skills.

dr D&C demonstrates teamwork skills every weekend. on purchasing a round of drinks that is too numerous for my two hands i shall call on friends to carry said drinks to the table. dr D&C also demonstrates leadership skills by delegating who shall carry what.

"you take the 2 guinessess first because they're for the guys right at the end of the table by the wall. i'll bring our ones over last as we're nearest to the bar. STAT. if there's time i'll sign your appraisal at the end."

the problems are not just with selection either. during the first two years after graduation the new doctors are continually assessed. i am not knocking this for one minute. i think continual assessment is an excellent idea. the issue is WHAT they are being assessed on.

my house officers have to be assessed on taking a history from patients, their clinical examination of them andbasic skills such as taking blood/cannulation.

these are NOT skills that new doctors should need to be assessed on. by bloody finishing medical school people should be proficient in the above. hence it is a phenomenal waste of their and my time. clearly this is designed to weed out the reprobates, the utterly skill-less. i would have hoped that they would not have made it through their primary degree but obviously the department of health does not have this confidence.

lots of important sounding professors seem to agree. 80+ of them wrote this letter to the Times last weekend (accompanying article here).

and the icing is that only the first two years post graduation of the MMC scheme has been formalised. NO-ONE KNOWS what will happen afterwards. years of uncertainty await.

in my opinion this restructuring is not about doing the best for patients or ensuring clear career progression for doctors. it is about money. the NHS has no money. it needs to keep on delivering a consultant led service. the MMC will do this (in name at least) in a shorter time than the current system. the fact that the consultants produced will have several years less experience is immaterial.

[i am still listening to Clap Your Hands Say Yeah]

something is amiss

i worked this weekend and it was actually very quiet and manageable with not too many disasters. i also had the pleasure of bumping into The Venial Sinner (yes we now work at the same hospital) doing his on call care of the neuro-screwed. he appeared to be keeping a tight rein on the ward exclusively from the cafe, on his lilo, copy of that sunday's observer in hand. ah! the quiet life!

the weekend was also my last on call pissing about with kidneys (pardon the pun ho ho.) i did do a three hour guest appearance on monday night before going to my "leaving do" which i shall tell you about at another juncture. i have as of today moved back to general medicine - diabetes to be precise.

it was very peculiar.

i have three house officers, ie 3 doctors who are junior to me who do all the mundane stuff (ordering on the computer, looking up results, etc). after we'd seen all the patients, i went off, had lunch and then had nothing to do. well i did supervise one of the kids draining fluid off some guy's lungs but other than that i was twiddling my thumbs at 3pm. i left work at 4.45pm and was home by 5.30pm. i only started work at 9.30 as well.

this is bizarre.

this is wrong.

this cannot be right.

i fear that i have walked into some children of the corn scenario where tomorrow at work i shall be killed by zombie doctors.

after a year of 8am starts and 7pm finishes i can't even appreciate an easy day without thinking something suspect is going on.

i'm SURE this is a freak even. i'm SURE that tomorrow it will all go tits up and continue in that vein for the next 6 months.

until then, tonight Dr Dazed & Confused is smiling if puzzled and may even drag himself out for a pint or two.

[i am listening to the debut from Clap Your Hands Say Yeah - an AWESOME album. i am also going to see the Go Team on Friday night]

Modernising Medical Careers: A Guide For Current Senior House Officers

here is a circular i received today:

dear doctor

good evening, hello and welcome to your guide to MMC!

now you may have heard a lot about this radical new restructuring of junior doctor training and this letter is to make sure you are fully clued up.

imagine you are a patient! you know... those annoying people who come into the hospital and get in the way of all your paperwork. anyway as you are well aware they perpetually drone on about wanting to see a consultant ie the "specialist" in whatever area they think they have a problem. you are also aware it takes a long long time to become one. that is because being the top of your field doesn't happen overnight does it!? as we write you are probably struggling through postgraduate exams, battling through a difficult rotation in the hope that you can then get onto your 5 year registrar programme and also maybe do a PhD to boot! how long is that going to take? you poor thing, i'd say about another 10 years! A DECADE! Before you're a consultant! Admittedly you'll be really great but a DECADE!

who wants to wait that long? certainly not the patients. so this is where MMC steps in. imagine this. what if we said to you we'd cut out 5 years of your training and took away the need for any research/exams? what if we also said to you that after this truncated training programme we called you junior consultants? you could tell all your non-medical friends (there must be one) that you were a consultant! wouldn't that be cool! and here's the clever bit... we could also tell the public that you were a consultant too! then they would be happy and so would our health secretary and uncle tony too! they'd be really please because Labour pledged to deliver more consultant led services and we would have delivered more consultants in a shorter amount of time! we would satisfy our masters and the public in one fell swoop. they would never know the difference between a junior consultant and a consultant (several years experience) much like no-one know the difference between labour and conservative these days. it'd be our little secret!

of course some people say that if you cut down training then the doctors produced at the end are substandard. Poo poo we say! in MMC you will have to tick boxes on forms every few months to say how well you can communicate with people. because after all, the public are happy if they get a nice friendly doctor to chat to. you don't actually have to make the right diagnosis or treat a problem correctly. we have data to prove this. the breakdown is 5% what you do, 20% how you look and 75% how you say it.

and where exactly do you fit in? there's an incy wincy problem here. we know that there are for the first time in decades plenty out of you out of work currently because woops! we expanded the number of medical school places but not the number of jobs. woops again! MMC really only applies to doctors who graduated last year. so you guys two to four years out of medical school don't really fit in to our plans. but you have a few options (there are always options. smile!):

1. get a registrar position by Aug 2007. that way you can do the old training programme and become a consultant the old way and probably be really good! it's not very modern though. and any of you who thought about taking a break to travel or do something else better not. time's running out for you lot. sorry for ruining any plans you might have had and not telling you this years ago.

2. wait till Aug 2007 and start MMC from scratch. you will of course have to work with doctors 6 years your junior and you will be hopelessly overqualified. but it's new and trendy! plus you will get to do blocks of placements like you did as a student in completely unrelated specialties! that won't help you if you really want to be, say, a gastroenterologist. you might frown and say it would be a waste of time but it'd be fun!

3. stay in your current position forever!!!!!!! the problem with MMC is that the new doctors, by virtue of their reduced training won't be able to do anything and will have to rely on you old school people to, for example, run the hospital at night. so we're hoping a few of you will stay on just to do that. if not we can always get doctors from overseas to do this job because frankly we wouldn't like our homegrown boys to take up slave labour positions with no career prospects.

there you go. please don't worry that you might become part of a lost tribe of doctors (though that too is cool! you'll be like Dr Littlest Hobo - going from place to place in search of work) - as we say on our website:

"In 2007, when the new specialty training will begin, there will be measures in place to ensure the doctors in the current training system are not disadvantaged. "

the funny thing is we haven't planned any of that yet and may not get the time to because of being so busy with the new graduates.

anyways! hope this helps.

all our love

the MMC team

our website

[i am listening to Beth Orton's new album, comfort of strangers]