Tuesday, March 21, 2006

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.


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]

Monday, March 20, 2006

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
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

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]

Friday, March 17, 2006

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]

Tuesday, March 14, 2006

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]

Monday, March 06, 2006

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]