Musings Of A Disheartened Doctor

see you all very soon

2008-01-11T22:12:00.000Z

*sigh*

*another sigh*

but not sighs of desperation, misery and discontent

no, these are sighs of relaxation, happiness and inner peace (albeit through the obstructed sinuses, productive cough and general shitty feeling that man-flu lends itself to.)

it has been just over a month since i left work. for the first time in four years i had the whole of christmas and new year (and also weeks either side) to relax and rest myself. money hasn't been an issue because i've been doing a few locum shifts (extra last minute shifts to cover illness, etc) at my old job. perversely, locum shifts are paid much much better than if one does the same shift as a regular salaried doctor. as anti-consumerist and anti-materialistic as i am, it is amazing how double (sometimes triple?) pay will make even the most mundane tasks bearable.

and, in a week, myself and Ms D&C (who has also quit her job) will take ourselves off travelling for a few months. i can't wait.

some have told me what i'm doing is mad, career suicide, etc. fuck them i say. i've never been one to do what i've been told. at the end of the day it comes down to what makes you happy (surely?) having said that, i do have a bit of a back up plan for when i come back. looking back at the stuff i've written in this blog, if i was to be honest, i don't think i ever really could leave medicine full stop. for all the shittiness and shitty shitty times, at the end of the day i think it's what i'm good at. given the short time we each have on this planet, i've come to the decision that by being a doctor i can still make a bit of a difference. i'm not saying i'm going to cure cancer or save millions. it's not about that. as time has gone on, i've realised that (for me) it's about the little things, the small changes, the conversation here, the bit of advice there that makes the difference. ripples in a pond.

what i think the problem over the past couple of years was that i've been dying for a bit of time out, respite if you will. now that i've got it, i'm VERY VERY content.

so this is not really goodbye (as i've been melodramatically threatening in the posts preceding)... more of a "see you later." i'm going off to have some adventures, experience a different way of life away from medicine, see the pretty colours of the world.

i do think i'll be back. i'm pretty sure i'll be back. hopefully i won't be a miserable bastard when i return. at worst i'll return pissed off to be home but at least ready to start afresh.

and at best i'll be a rejuvenated person with a few exciting stories to tell.

i'd also like to thank everyone who comments/supports/encourages me to continue this blog. even if i don't reply, i do read every single response.

so long everyone. i'm not sure when i'll next post but i'll see you all very soon.

much love

[i am listening to She's A Rainbow by the Rolling Stones.]

Musings Of A Disheartened Ex-Doctor

2007-09-27T19:23:00.000+01:00

well that's not quite true.

however i did resign today.

i'm not quite sure how i feel. come january there will be no more of this nonsense.

the future awaits.

[i am listening to Wilco]

the MOADD twilight

2007-08-05T18:37:00.001+01:00

it's been a while since i've put fingers to keyboard on here.

i blame (in particular order):

1. general tedium with the medical blogosphere - my ranting about Modernising Medical Careers, the general shittiness of the medical profession in the UK and ennui with the lack of control of my career and life is starting to bore even me.

2. Facebook - i thought this would be a fad that would die in a few months but sadly no it is taking up a large part of my internet time.

since the last time i wrote, things have changed and i've done quite a few things.

i went to the amazing Latitude festival in Suffolk. i had a spiritual experience watching the Arcade Fire.

i went to Cornwall and ate well, surfed and lazed around.

i've been getting into the british street art scene and went to a couple of private shows in uber-passe Shoreditch. not tempted to buy anything yet.

i spent about three months not doing any on calls, sitting in outpatient clinics looking after the elderly. a very rewarding and chilled out time. i miss it.

i am also now a Member of the stupid Royal College of Physicians which means nothing to most people and in reality means nothing at all. except that i finally passed some exams and 3 grand simultaneously passed out of pocket. i have a few more letters after my name.

i have left my hospital (where i was for three years) and moved to an even bigger hospital to work in intensive care. it's ok. the doctors however are all posh toffs who don't listen to anything you say. i may as well be invisible.

i am planning to resign in January and go travelling for the rest of the year. this is career suicide as i obtained a training position for 2007-8 unlike thousands of my peers. but frankly i don't really care anymore.

i think that i shall probably delete this blog soon. it hasn't really served the purpose that i felt it would but it was fun while it lasted.

i'm dreaming of far away places. the sun is setting here.

Dr D&C is disheartened with blogging

2007-06-07T12:13:00.001+01:00

this man is a genius

2007-04-30T19:11:00.000+01:00

i have been far too busy to post recently. i am burning the fun candle at both ends as they say. this weekend i have been at All Tomorrow Parties and a jolly good time i had too. anyways i am now a nick cave fanatic and i urge you all to be fanatics too.

[have a guess at what i'm listening to sherlock]

i am honoured to have this man as a friend

2007-04-02T19:05:00.000+01:00

i wrote about him a while back. long time readers of MOADD will remember that a year ago current medical students petitioned the government/DOH/MMC people regarding the stupid system they had to use to apply to their first medical jobs after graduation (have a read here - sound familiar?) i at the same time condemned the medical student leadership in this country as being a bunch of sycophantic wankers. hmm... medical student reps... wankers... doctors' leaders... ineffectual pricks... everybody... sold down river... hmm. i feel there may be a connection here.

anyway my buddy orchestrated this petition against the moronic system. it got some press. it got noticed. for his troubles he got asked to join the MMC team to represent students and help make it better. he slowly realised that he was appointed to be used as PR, to silence the protesting masses. as a result he resigned his position in MMC. here are his eloquently polite yet damning letters to the mendacious serpents:

____________________________

This is my letter of resignation, as sent to Professor Crockard 18/03/07.

Dear Alan,

I am sorry to inform you at what must be an impossibly busy time that I wish to resign from my position as medical student advisor.

When I took the position I had many reservations with the MMC systems but believed that I would be able to help students get the best deal from these changes. Seven months on, I retain these reservations and regret that I have not been able to have the impact I had imagined.

Now as then (when I presented you with a petition signed by 1300 students), I believe:
• The nature of the new application system effectively randomises medical students to jobs across the country
• The importance of academic achievement has been downgraded
• The importance of other achievements at medical school has been nullified by the nebulous nature of questions and the lack of a CV
• Two years is not long enough to decide on one’s specialty, to gain a broad enough range of experience, to become a good enough doctor: pressure is on to decide early, but the random nature of the application leaves no scope for strategising or planning ahead
• Morale at medical schools is low; they are not the aspirational, centres of excellence they should be, rather ‘centres of competence’
• This anxiety has filtered down to those students considering applying for a place at medical school

Through contact with a wide range of students over the last seven months, I know that these views are widely held. Just two nights ago, I talked to a Bristol student representing a group of 40 who echoed my above sentiments. I have, however, come to realise that continuing to transmit such views to the MMC team can have no effect as it is focused on the successful implementation of a system rather than the guiding principles and details of that system.

In my limited experience, the role of student advisor is not used, as MMC aspires, to ‘encourage dialogue with the stakeholders’. Instead the role seems to be a token attempt to suggest the involvement of students in MMC strategy; a publicity vehicle to lend validity to a system that has not, in fact, considered student opinion and insight at all.

When I was asked recently to find some students / SHOs who were happy with the new system to help build some positive press, I knew this role was not for me. I am not interested in spin or image, in making something seem other than it is. I am interested – perhaps naively - in getting the popular voice heard and acted upon and in standing by my own personal, political and professional principles. I now realise that in order to do this effectively, I need to be working within a different framework.

I would like to thank you for giving me the opportunity to fill the role and personally wish you all the very best for the future. I can honestly say that I have enjoyed meeting you and having the chance to work with you and the team as a whole.

Yours Sincerely,

Alex

This is my letter as sent to the CMO 31/03/07:

Dear Professor Sir Liam Donaldson,

I recently resigned as medical student advisor to MMC.

Despite claims from the health minister that the new Foundation Programme has ‘widely been acknowledged as a success’ there are, and always have been, huge misgivings about it at student, junior doctor and all other levels. I hoped that access to the MMC team would give me an opportunity to make these views heard. I was wrong. Although you continually tell us that you are ‘working with the profession’ you are not, at any level, listening to it. This is why I resigned: please find enclosed my letter of resignation to Professor Alan Crockard.

From a grassroots level upwards, your recruitment of those from the profession has been tokenistic at best. My role was little more than a publicity stunt. You want to be seen to be involving us but care little for the reality of what we actually have to say.
Even at the highest levels you have been seen to charge professionals with responsibility but withhold authority.

It is not my job to outline the infinite professional, personal and philosophical problems that blight your new systems – the 12,000 junior doctors who recently marched through London could do this more eloquently than I could ever hope to – but it is my job to expose the growing chasm between yourself and the profession.

Your agenda does not meet with the approval of the profession. You must acknowledge this. It is not acceptable for you to enlist members of the profession from all levels and to then ignore them. It is not acceptable to use your implementation team – MMC – as a vehicle for spin, as a way to convince the profession that things are other than they are. It is not acceptable for you to hide behind the responsibility you have dispensed to MMC and at the same time maintain your authority so you can push through your own agenda.

And yet, this is what you are doing. No matter what the profession says, no matter how vociferously it protests, no matter what damage is done to families up and down the country, this is what you will continue to do. How kind of Lord Hunt – at a time when faith in your systems is at its nadir - to illustrate the DoH’s utter contempt for the profession, by saying “I would like to reconfirm our commitment to MMC which aims to recruit and train the best doctors to provide the best possible patient care.”

This is your project. Everyone else – from MMC to MTAS, from the royal colleges to PMETB, from the advisors to the spin doctors – are merely your implementation tools. Ultimate authority rests with you. It is now time for you to take responsibility. If you continue to force through these reforms, I want you to know that it is obvious - even from a medical student level - that you are a million miles away from being the ‘bridge between the profession and the government’ that you claim: you could not be acting more undemocratically if you tried.

If you find this image unappealing, your options are clear: take heed of the groundswell against you and your agenda and cede your authority back to the profession. If this is also unpalatable to you, then you must resign.

Yours Sincerely,

Alex Liakos

_______________________________________________

what i love about the letters (apart from beautifully expressing the bigger picture of MMC) is the way they say FUCK YOU CUNT so politely. thinking about my buddy, he is actually the consumate gentlemen, even if he is from southampton.

anyways, he's far too busy with things that are bigger (or littler...) and more important than MMC at present, to which i wish him the best. i'm sure i'll see him soon and there'll be much to celebrate. it's a shame however that i am STILL keeping my pessimistic hat on: i don't think it'll make a difference to this imbecilic process. it is going to continue. at least with the march, the press coverage and letters like these, we can say that the medical profession in the UK, even if it was a bit too much too late, went down guns blazing.

see you soon dude. i've got a pint of guinness and some tea trolley treats waiting for you.

[i am listening to the new Kings of Leon song. they've shaved off their tashes. i'm distraught.]

without a paddle

2007-03-15T19:50:00.000Z

MMC steering committee holds urgent meeting to modify the online application process (Prof Alan Crockard, far right)

and so the crisis goes on

this week the department of health announced that the process by which 30000 junior doctors are applying for 22000 jobs is to be urgently reviewed.

the reason for this was that several groups of consultants on interview panels refused to participate in the process on the basis that the entire selection system was moronic.

i have mixed feelings about the actions of these consultants. on the one hand i am glad they spoke out and got a review to take place. on the other hand i pose the question:

where the fuck were you guys nine months ago?

this disheartened doctor has been wingeing about MMC since last year. everybody in the medical profession knew this was going to happen and knew that the implementation was going to be a joke. we knew this from the way the newly graduated doctors had been treated by a similar system. yet the warnings were not heeded. our union, our royal colleges and our bosses sold us down the river with a group shrug of the shoulders and an indifferent "well who knows what's going to happen" whilst all along we were screaming "it's a shit idea, it's going to be shit and it'll fuck up our lives, your lives and those of our patients."

so this review: i'm not convinced. not convinced at all and sadly don't hold the views of my fellow learned bloggers (here and here for example) though i wish i did.

the first round of selections is nearly over. there is talk of the second round being modified to be "fairer."

what this actually means, and we can debate for days about what modifications should be made, is that MMC will continue, we WILL do exactly what we are told to do and we WILL BLOODY WELL LIKE IT. it is marxism at its most literal. you will be allocated and perform the task that we deem you appropriate for.

patricia hewitt and the department of health: why can you not see that our NHS is held together by the altruism of its nurses and doctors. you've already slain the nurses (below inflation pay rise this year most recently) and through MMC you've killed the morale of already demoralised doctors. the boat carrying our altruism is sinking because you've punctured so many holes in the fucking hull. time is running out patricia. how can you not see this?

HOW CAN YOU NOT SEE THIS?

there is a protest march on saturday. i shall certainly be attending. so shall many of the british medical bloggers. will it make a difference? i doubt it. optimistically it may burgeon public support. realistically the public will probably wonder what all these rich doctors are bitching about, the power-obsessed bastards. pessimistically i think 10% of the doctors who say they are going to attend will actually show up.

for we are the most ineffectual group of lobbyists ever. oh for being a bit more militant and bit less self-serving (like the new zealand junior docs who took strike action last year).

i've been eyeing up the canadian medical board exams. even if i get a job for august, what precedent does the behaviour of the DoH set for working in the NHS in years to come. i personally can't wait for the next set of "reforms" circa 2008. surely better to go somewhere or do something where you are valued as a person with skills to offer society.

i'll report back after the march. i really hope that there will be a sea of angry doctors there, like Sauron's army of orcs and that the british public will be thrusting their fists into the air and willing us to go and give the DoH hell.

but i worry that it will make no difference. i worry it's too late. i worry that come august this will all be done and the protests of the future physicians, surgeons and professors of this country on saturday will become but a whisper in the tragic history of the NHS.

[i am listening to the new Shins album]

ps. this is fucking psychedelic genius:

the slimiest of slime - something reptile

2007-03-03T13:32:00.000Z

the HAL9000-esque automated medical job allocation process robot (MTAS) sent me to an interview last week. let me tell you about the moronic sequence of events running up to this interview.

regular readers will know that the Lost Doctor filled in his online application whilst snowboarding in Whistler at the end of january. by doing this i achieved 2 objectives:

1) i managed to avoid everyone at home stressing out immensely about the idiotic questions that needed to be answered
2) being on holiday was a great panacea in reducing my outrage at the idiotic questions

the system crashed due to the sheer number of applicants several times. little space was given for detailing achievements in medicine to date. the details of jobs available were sparse and uninformative. after finally submitting my responses, i was inundated with daily emails informing me how there would be more delays as the system was not getting people's references and that the shortlisting process was taking too long. i overheard one of my consultants two weeks ago saying how she had been couriered hundreds of applications and asked to score them all in a day. she also said how she didn't feel the application form was a particularly good discriminator of good from bad doctors at all and that is was all a "fucking painful joke."

friday (23/2/7) came and i began a weekend of nights. it was a lot of fun because i had the company of the venial sinner (MIA in the blogosphere but very much about in reality) who was also doing nights. at the same time MTAS emailed to say that the shortlist which was supposed to come out that day would only be revealed the following monday. the venial sinner and i decided that after finishing our night shift on monday morning we would go out on a bender to recreate the halcyon student days.

10am monday morning (26/2/7) and tvs and i headed into town for the obligatory caner. at about midday i received a call from vegas who informed me that MTAS had crashed and died again. no-one knew about whether they had been shortlisted for possible employment in medicine in this country for august. tvs and i continued to drink and drink. 2 tycoons (triple sec, apricot schnapps, gin, cointreau, lemonade) and 2 long island ice teas later the eyes were drooping, the gait was ataxic and home and bed beckoned, oblivious to the fact that MTAS was secretly sabotaging the airlock doors.

i woke on tuesday (27/2/7) and went to my outpatient clinic where i checked the website. MTAS said that i had 2 out of 4 interviews. i quickly booked interview times online (gone are the days of someone phoning you) and continued on with a busy clinic.

while awaiting MsD&C's return from work that evening i decided to consult MTAS again (who had by now killed the astronauts in hypersleep) to double check when my interviews were, as in the rush of the clinic i had neglected to note this important detail down. upon accessing his mainframe i found out i had a third interview. attending this interview would require a day off work and a not insignificant train ride. oh yes and it was the following day.

thanks for the notice.

i hurriedly scrabbled together a portfolio with the ridiculous number of things that i had to take there. i also printed out my answers to the questions i had completed one month earlier in canada so i could review them before the interview.

i felt sick.

i read back some of my answers. they were PAINFUL.

when you're writing the twentieth draft of something you become quite dissociated from the content. you're concentrating on grammar and flow.

i was ashamed i could come out with such drivel.

i attended said interview the following day. it was quite funny actually because, finding dry shirts difficult to iron, i said out loud in my flat "fuck this, i'm going to wear the clothes i had on yesterday" and went to the interview smelling of urine and C.difficile.

i hate waiting for anything. being an hour early, i quietly sat in the waiting room drinking water and listening to the five other candidates chat to each other (Dr D&C was ignored probably because he isn't posh enough).

sometimes when you walk into a pub or a bar you can sense an atmosphere of foreboding. in these cases the correct action is to finish your drink and leave quickly without drawing too much attention to yourself. sometimes when you meet someone for the first time you can tell that they are complete utter wankers. in these cases the correct action is to bite your lip and pray they move on to bother someone else.

well these five people were amongst the biggest fucks i've ever met in my entire life.

oh the pain! the continuous, self-serving, droning conversation. the false smiles, the belly laughing, the lack of grounding in any plane of reality. i wished the aliens from war of the worlds would appear and disintegrate them all. i prayed for their unnecessary fountain pens to fly out of their pockets and impale them in their foreheads. everything they talked about was prime, chargrilled bullshit and they were loving it.

and then i realised what it was. i realised what it was about these people that made them all so similarly disgusting examples of our species, and why i was so unfortunate to be breathing the same air as them.

they had all been summoned to this place on the basis of their answers to the stupid questions on the application form, answers that encapsulate their inflated egos and sense of self-importance. i felt like bruce willis at the end of the sixth sense when it dawned on me that i too was one of them. cheapened.

the interview was fine in itself. one of the panels didn't have my application form and so knew nothing about me. the interviewers seemed fair and normal people trying to make the best of a ridiculous situation. at the end of the day it wasn't too dissimilar to any normal job interview. just the getting there, which was marxist to say the least.

and all the way home i couldn't stop thinking about the cunts in that waiting room. this new medical system will roll on because people like them will secure their jobs and then they won't care about their colleagues (if such care ever existed.) there is a protest march on the 17th of this month. do you think any of them will go? course not. they have their interviews. fuck the rest of you.

be warned the UK public. from august your hospitals will have greatly reduced numbers of doctors working at night in an effort to make the NHS balance its books. when you finally do get to see a doctor it won't be someone experienced able to deal with most of your problems. MTAS has ejected these doctors from the cargo hold.

no, what you'll be left with is these five penises, appointed because they are adept in using buzz words such as "motivated" and "empathy" and "nonce." these are the sort of people the NHS of 2007 want to employ. i hope to god i'm not one of them.

people of britain - do not got to hospital after august lest you come across such people in a dimly lit examination cubicle. it is time to stockpile the ibuprofen, turn your kitchen into a operating theatre and find a good VET to look after you when you get ill. medicine in this country has been sold down the river by the government, the royal colleges, our "union" the BMA and our bosses because, as jarvis cocker recently said, cunts are still running the world.

[i am listening to willie nelson]

culling

2007-03-01T21:22:00.000Z

this week has seen the biggest culling of junior doctors' career aspirations by a computer system and an ill thought out application form (MMC and MTAS respectively - i've talked about this before). this is probably the biggest change to medical training in the past forty years and within days hundreds of doctors have had their dreams of pursuing a medical specialty shot down. it's like the beginning scenes of saving private ryan. i, unlike many, have survived the initial onslaught of career killing fire and shrapnel. i am currently lying on the normandy beach of possible interviews, unsure of my future. i know a LOT of doctors who've been *BANG* taken out just like that and will have no job to go to in august. some of them (the ones with slightly more experience) will probably never work again as a result. absolutely gutting. absolutely fucking gutting.

the most eloquent explanation of what's been happening is quoted below and taken from the doctors.net.uk forum. i'll let it speak for itself:

"I feel like crying.

All my life there has been only one thing that I have wanted to do. I worked hard at school to get to medical school, I then worked hard at medical school to give myself the best shot at the jobs I wanted later on. I passed all my exams, won a few prizes along the way and was generally a good all rounder.

I was warned off medicine by my family and friends, they said it was too stressful and the NHS was in trouble; but I found the subject fascinating and it was not a matter of choice for me.

I have worked hard since I qualified and have had good references from all my employers. I have not taken a single day off ill in my first few years of work, and there are days when I have not felt well enough to come into work. I have passed several postgraduate examinations and attended all the relevant courses, as well as having several articles published in scientific journals.

There are many others just like me. Each of us has made numerous sacrifices because we love what we do. Our study budgets and study leave quotas have been cut, meaning we have had to pay for our own training and attend courses in our annual leave. The trust has also stopped properly reimbursing us for our travel expenses and removal costs. However we carried on because we thought that it would all be worth it, if we could have a job at the end of it doing what we loved.

These last few weeks have been the final straw for many of us. We have been subjected to the most unfair and least meritocratic selection process ever seen, MTAS (medical training application service) via MMC (modernizing medical careers). We have had to sum up our years of work and experience in several politically correct short answer questions, on which we are then judged. Examinations, experience and references are all but ignored in the pursuit of vague waffle.

The computer system crashes time and time again, confusion reigns supreme and hundreds of consultants are appalled by the process. Yet it is allowed to proceed. The short listing results are released in dribs and drabs and thousands of juniors tap away on their keyboards in a state of sheer panic, realizing that their future is being decided by the MTAS tombola.

Some of us have been lucky enough to get short listed for the jobs we want, but we shouldn’t have had to be lucky. The process should have been meritocratic, well organized and fair. It was most definitely none of these.

Young doctors such as myself are appalled by what we have had to endure this year. No one should have to go through such a process again. We all know people who are going to have their hopes and dreams crushed by this cruel joke of a system.

Shame on those who are behind this scheme. Many a tear will be shed this week by many brilliant young doctors who have had their hopes and dreams crushed in a quite barbaric fashion. Many of us will emigrate and many of us will leave the profession; I hope those behind the scheme are proud of these achievements.

Of course we do not all expect to be handed our perfect jobs on a plate. However we deserve not be lied to, we deserve not to be treated unfairly and we deserve to be treated with a little more dignity, respect and humanity than we have in 2007."

(Dr Ben Dean)

our union, the grossly ineffectual bunch of sycophants the BMA, have done precisely fuck all about it. i think they may have indulged the architects of MMC in fellatio at some point. they yesterday announced a press release saying that the system was failing.

erm STABLE DOOR CLOSING, HORSE, FUCKING BOLTED.

[i am listening to Johnny Cash]

my cup runneth over with honey lager

2007-02-13T18:38:00.000Z

no the NHS didn't finally kill me.

i've been on holiday for 3 weeks.

Ms D&C and i returned to my spiritual home, vancouver, with a view to collect rent from all the canadians who've been staying at my flat over the past three years.

it was fantastic. with each visit i struggle to answer why i don't move over there. my friend Broseph (who with his lovely wife let us stay for 2 of the 3 weeks) said that if i did go and did a masters degree he'd jack in his job in music production to do one with me. i did remind him that we would probably spend most of the time looking up stuff on youtube and flunk badly. he agreed.

highlights, apart from the copious amounts of red meat and pale ale consumed, were far too many to list.

we visited MsD&C's great aunt and uncle on vancouver island, caught up with Roger Dean Young and the new Tin Cup who played a gig in town, bid farewell to a friend and Tin Cup member moving to Toronto, stayed with another of the Tin Cup in his log cabin on the sunshine coast and gushed at a new baby arrival for two other friends. much of it involved hanging out with people but we were quite outdoorsy too: hiking, cycling around stanley park and finally snowboarding for a week in Whistler with Gnarls Barkley (whose MSF trip appears to have gone tits up) and his latest and greatest girlfriend. he'd come over from Edmonton, Alberta for a "conference" and managed to divert to spend some time imbibing with us.

i think i managed to see pretty much every canadian i know. i've also got a real bug again for snowboarding and am trying to get away again this season. any ideas of good destinations? anyone got a 150 burton board for sale?

i've come back in holiday mode to a much less stressful job and am floating on with memories of good times and fresh air.

i realised when i got back that everyone was incredibly stressed out about MTAS. for the non-medics this is an online application process which (nearly) every doctor who wants to work in august has to complete. it is analysed, processed and then refined into energon fuel which powers a huge robot who then allocates jobs. there has been a lot of worry because it's been poorly implemented, not carefully thought through and there hasn't been much information regarding how many jobs are available and how people will be selected blah blah blah

in short nothing that should surprise you about the NHS.

i did my form when on holiday. very much less worrying when you complete it after spending a day boarding. i also submitted it from the sleepy town of Squamish, British Columbia whilst waiting for a bus. very relaxing as it happens. probably fucked it up anyway.

anyways life is still uncertain, frightening and depressing. at least i know for the next few weeks, until the holiday feeling wears off, i can close my eyes, let all the stress wash around me and daydream of snow and mountains.

[i am listening to Concerning the UFO Sighting Near Highland, Illinois by Sufjan Stevens]

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

2006-12-09T21:20:00.000Z

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

2006-12-05T13:33:00.000Z

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?

2006-11-27T11:10:00.000Z

"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

2006-11-25T11:28:00.000Z

*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

2006-11-13T21:40:00.000Z

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

2006-11-08T18:34:00.000Z

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

2006-11-03T21:25:00.000Z

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

2006-10-27T18:18:00.000+01:00

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?

2006-10-15T18:06:00.000+01:00

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!

2006-10-09T11:54:00.000+01:00

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

2006-10-04T10:29:00.000+01:00

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

2006-09-23T19:00:00.000+01:00

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

2006-08-19T18:31:00.000+01:00

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

2006-08-14T22:25:00.000+01:00

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

2006-07-16T07:02:00.000+01:00

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

2006-07-11T19:24:00.000+01:00

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

2006-07-10T15:56:00.000+01:00

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

2006-07-09T20:47:00.000+01:00

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

2006-07-08T01:16:00.000+01:00

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

2006-06-15T20:16:00.001+01:00

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?

2006-06-05T23:40:00.000+01:00

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!

2006-06-03T09:35:00.000+01:00

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

2006-05-31T16:10:00.000+01:00

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...

2006-05-13T15:20:00.000+01:00

... 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.

2006-05-08T21:56:00.000+01:00

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

2006-05-03T20:15:00.000+01:00

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?

2006-04-30T13:29:00.000+01:00

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

2006-04-20T20:33:00.000+01:00

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

2006-04-14T13:32:00.000+01:00

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

2006-03-21T12:03:00.000Z

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

2006-03-20T13:32:00.000Z

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

2006-03-17T21:45:00.000Z

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 Pad dington 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

2006-03-14T19:01:00.000Z

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

2006-03-06T18:44:00.000Z

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

2006-02-28T14:13:00.000Z

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

2006-02-16T03:36:00.000Z

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]

i choose hell

2006-02-12T18:26:00.000Z

Dr P was a miserable man. i first met him in 2000 when i, as a fresh faced medical student, was spending time on a cardiology ward at one of the london teaching hospitals on placement. he was a registrar (not quite consultant), quiet, not up for any bullshit, happy to have a go at you (quietly) if you didn't know your stuff and seemed ever so world weary for someone who must have been about 34 years old. he was of course fiercely intelligent, hardworking and career minded and even then i knew that he would go far. his long fought after consultant post was surely looming.

last night, 6 years on, i receive a transferred patient from the same cardiology department at the same hospital. as i trudged through the dreary reams of photocopied notes imagine my surprise when i see entries from Dr P. the same concise instructions, the same copperplate handwriting, the same aura of tiredness... and yes still in the same position. STILL a registrar after all these years.

i couldn't believe it. i knew he'd been a reg for at least 4 years when i was a student so to date he must have been in the same position for at least 9 years.

he has been slogging his guts out for so long and has moved very far sideways. he was passionate about his subject and keen to please his bosses (they seemed to love him) and where has it got him? nowhere. what kind of job ensures that you do not progress after 9 years service.

i realised that night (in a fred savage wonder years voiceover moment) that tieing myself to hospital medicine (as i am 95% sure i have) is no guarantee of any progression to becoming a specialist in my field, no guarantee of any ascension to the right of some autonomy to research and practice as an expert. i too may flounder despite having years of experience when i am close to 40, hanging on the crazy whims of my superiors whilst around me the rest of life dessicates into a shrivelled world-prune, PURELY because the NHS has no scope to provide a clear career structure and trajectory. how passionate do you have to be to tolerate that? i have chosen a pathway to specialist medicine. i also appear to have chosen a pathway to (my idea of) hell.

"this year Dr D&C you will be doing a year of nights."

[i am listening to will you still love me tomorrow by the shirelles - i am DJing at a wedding in April and though it might be a good slow dance despite the lyrics]

shambles

2006-02-11T10:41:00.001Z

my fear of total carnage on starting nights in doctor changeover week was confirmed. fortunately the doctor covering before i began my shift is a bit of an old hand and was almost on top of everything but there was still a load of crap to do.

renal medicine is all about pissing. if you piss that makes us happy. in fact a lot of medicine is about pissing. it is guaranteed that very soon into their first job a newly qualified doctor will be called up at an unsocial hour with the (in)famous "you remember Mr Eriksson, the football manager who's had his stomach taken out today? well he hasn't passed any urine for four hours." this is very important because the amount of urine someone passes is a good indicator of how well hydrated they are and whether their kidneys are receiving adequate blood flow. so the appropriate response to that call is to make a full assessment of the patient and their fluid balance. i must add that it is the appropriate response. the reflex response might actually be tempted to say "well doctor here hasn't had time to pass any urine all day but no one gives a shit about him."

so imagine my frustration to be told that the ill looking young guy in the side room, yes the one who's kidneys not only failed years back, but his first transplanted kidney failed and has been admitted cos his second bloody kidney transplant is also failing because of roaring infection, has not passed any urine all day. "i told the doctors during the day" said the nurse "but i'm not sure if they did anything." un-fucking-believable. this is the bloody RENAL unit! the whole bloody point of him being here is so that we can SAVE his transplant. anyway i wasn't happy. though i think i was happier than his melting kidney.

i was also pleased to receive a torrent of abuse at 6am from the guy who was supposed to go to theatre today for his surgery. i was told by the day team "oh yeah, can you check his bloods early in the morning as we want everything to be OK for his op today." yeah sure guys no problem. oh yeah, you might want to actually TELL the patient, nurses, surgeons, anaethetists and theatre staff that he's supposed to be having surgery. does help in my experience. so i got a lot of:

"you fucking cunt, you can't just fucking swan in here to take my bloods and tell me i've got to got for an op when no-one's told me fucking nothing. you're all cunts. i'm sure i've got MRSA from you dirty cunts. i'm gonna fuck you all up"

and so forth. but, by this point, the sun was rising, i could hear the birds singing and i'd spent 40 quid on Amazon buying CDs so i wasn't offended.

[i am listening to Get Free by The Vines who apparently have a new album out soon]

bleary eyes

2006-02-10T19:12:00.000Z

http://thismassage.blogspot.com/

check out this blog. it is hilariously mad in a "i am delirious" kinda way. i have images of kevin spacey's character from Seven sitting behind a computer.

[i am listening to Float On by Modest Mouse]

not quite dead

2006-02-10T16:34:00.000Z

no i haven't emigrated (yet) but i have been a little too distracted by other things to refill the blog of late.

i have however managed to travel around the country (taking in wales, hereford and nottingham) and spent a week snowboarding in Italy (i did take a tumble on the dunes and fear that i may have fractured my coccyx.) i have also failed my Part 2 exams (hurrah) but instead of self-flagellating have turned my attention to enjoying myself. in the pipeline i do have another visit from a group of canadians (their band are playing in london in march), tickets to sigur ros, a stag weekend and a week in stockholm. so all is good.

of course this shall be preceded by the ritual week of nights. happy happy joy joy as a tail-less cartoon cat once rejoiced.

furthermore this wednesday heralded the biannual changeover of doctors.

a quick word to you. NEVER EVER EVER be admitted to a british hospital in the first week of february or august. the NHS in all its incredulous wisdom ensures that every single junior doctor in the UK changes positions/hospitals on these two dates.

i haven't changed over for various reasons but our department is amok with new doctors who do not know how to do anything (because they have never worked at my hallowed hospital before) and hence i have had to carry the burden once again. this is not so bad except that i have left work very late the past few days (change the record) but a little disconcerting because, as i am on nights from today, the ward will be left in the hands of doctors who have never done any renal medicine at all.

hence, i apologise for my absence. i am not quite dead but after this week i cannot guarantee the same of the patients.

ciao ciao

the most depressing things about the age you live in - the list

2006-01-05T16:45:00.000Z

leading on from the point before, i suggest we compile this list. please leave your suggestions in comments and i shall collate them at some point. then you can print it out and stick it on your wall, or email it to colleagues. and then maybe it shall be used as soundbite for some talking head on BBC2 or perhaps even get it's own spin-off series on Channel 4. "The Best Worst Things About The Modern Age Ever" - can you imagine?

whilst i'm here please go and see NHS Blog Doctor for a dark, funny, eloquently written weblog by a similarly disheartened doctor (albeit with much more experience. i don't think he has much hope for me - or my patients...)

two thousand and six

2006-01-05T15:38:00.000Z

happy new year my friends. i hope that you are all dusting off your gym memberships and promising to be a little nicer to your fellow humans in the months to come.

i managed to forget the travails of my special christmas nights on call with a quick sojourn to the countryside (ah how the urban squalor is being knocked out of me as time ticks on) for new year weekend and a meeting of minds with my dear vegas oop north on tuesday. a grand round if you like. i think that, having missed out on any human contact outside of work over the holiday period, this period of post-nights recuperation has been extremely therapeutic for my emotional wellbeing. i shall return to work tomorrow beaming. i do have the weekend to do but let's set that to one side.

vegas and i did not make any headway in the search for life/job satisfaction. there were no answers to be found and we have conceded that four months after starting our blogs we are no better off. we did however discover that rio ferdinand is a waste of space and that jose antonio reyes should perhaps be referred to a local falls assessment programme. we also found out that it is possible to dance without a care in a club filled with less than twenty people if the Arcade Fire are playing and enough Red Stripe/whisky has passed over the bar (the venue happened to a be a local indie nightspot and as such was "filled" with A-level students as comes with the music - how old we felt and looked).

the news has been eyeopening and tearshedding in equal measure over the new year period. there appears to be a glut of horrible things happening to young children. i am never sure if this reflects a Catholic degeneration of our society or whether we are just more aware of such sinister goings on as a result of increased reporting.

incidentally, i did note that the e x-director of NICE (national institute for cost effectiveness) was struck off for perving over kids on the internet. well, grooming teenagers on chatrooms actually. he has since resigned from his position as director of the Institute's Interventional Procedures Programme. suspiciously, a week before that, all catheter ablations were cancelledby an oxfordshire NHS trust. (an interventional procedure whereby the electrical wiring system in the heart is altered to prevent funny unpleasant heart rhythms.) coincidence? i don't think so... you just don't know how deep the conspiracy goes. straight to the president. they knew about it all along, etc etc

i also watch with trepidation at the progress of Ariel Sharon more for what it will mean for the middle east (those three words are now the stock epithet for the Israel-Palestine conflict) which by the way is surely high on the "most depressing things about the age you live in" list. besides if he's on the neurosurgical ward he's probably been left without any fluids and his urinary catheter clamped, whilst the infected bedsore slowly disseminates MRSA to his bloodstream. much like the poor bastard i was referred at 4am on christmas morning ("perhaps you would like to prescribe him some antibiotics that might actually kill the bacteria responsible for his sepsis rather than just give him the shits and make his life even more miserable" was my final suggestion before leaving).

this new year i shall also be keeping a close eye on the activities our dear health secretary who is fast becoming the government's Emperor Palpatine to our pathetic rebel workforce. soon you shall feel the awesome power of her fully operational private health service.

i do, as always, have a theory.

it is my fear her multiple trips across the galaxy via some kind of interdimensional wormhole excavated from beneath the desert in Egypt may have affected her mental health. worse still, i suspecting that she may be currently influenced by some kind of symbiotic all-powerful alien being who, inhabiting her human body and feeding off her very life energy, is hellbent on crushing any decent medical care for this country's people whilst simultaneously strangling the motivation of its doctors. we shall see.

Patricia Hewitt, Health Secretary, pictured above fielding questions from journalists

James Spader, actor, pictured above in "Stargate"

[i am listening to Liezah by The Coral]
[i have just finished reading We Need To Talk About Kevin by Lionel Shriver. absolutely amazing - i did hate the main character for most of the book and then you read the last three chapters. i was blown away. certainly one for your list.]

the christmas of a disheartened doctor

2005-12-23T18:50:00.000Z

it has been five extremely busy days. work has been punishing as always with insufferable late finishes.

the big plus was that my good old bro-seph from Vancouver has been in town so we have been schmoozing around london all week. it has also been quite heavy from a beer perspective and i have had to tolerate his insistence on drinking Newcastle Brown Ale which, for those uninitiated, tastes like tepid hard water. i on the other hand much prefer the gaseous slip of monsieur kronenberg.

but i have been trying to condense the best and worst of London into a few evenings and i certainly have a had an absolute ball. we were privvy to a performance by the worst singer-songwriter in the world at the 12 Bar on Denmark Street. there are photos and video footage which i shall endeavour to post.

needless to say i am shattered by 2am bedtimes and 6.30am wake ups, in addition to the sheer amount of crap at work such as the inability of a handover to be completed at 5.30pm, not because of sick patients but because people are too busy getting cups of tea, discussing their plans for the holidays etc.

ah yes holidays.

as mentioned before i am NOT going to be seeing any loved ones this year (excuse me, for the THIRD year in a row) but instead am getting ready to go into the hospital. it would of course be impossible to organise a rota where the holiday period shifts are equally divided amongst staff so that everyone gets at least one day off. no much easier to completely screw one doctor over (well two - the poor bastard who has to do the day shifts over xmas). so today after waving off my friend and then snatching a few hours with my special ladyfriend before also waving her off, i have been twiddling my thumbs at home. she has kindly left me loads of presents to open on christmas day and made a hamper for me to take in on christmas eve (she is the best!) but it's no way the same.

this christmas eve, santa will do his on call (1 in 365) whizz through london whilst i shall be on the ward trying to make the best of it. and then i shall return home on christmas morning (though i am not sure how because there is no public transport and hmmm of course the hospital has organised transport for its workers not) to my cold flat, maybe eat my turkey dinner for one or perhaps forgo it in favour of sleep. then, whilst families in the rest of england sits bloated in front of the telly, i shall begin my trudge again into work.

i love medicine. everyday i work as hard as possible and try to do the best for the patients even when my motivation levels are below zero.

but, i really did not sign up for this continual soul whipping.

anyway (this is sincere) wherever you are and whatever you are doing, have a great christmas everyone.

[i am listening to one of my favourite songs in the world: one of these things first by nick drake]

saturday sun

2005-12-17T18:44:00.000Z

it is very exciting this weekend. the weather is gorgeous, i am not working, chelsea play arsenal and tomorrow...

... the canadians arrive.

[i am listening to the decemberists]

what are the chances of that happening

2005-12-13T20:51:00.000Z

today i have mostly been wiping my fucking nose and tolerating that boring into your eyes feeling when you get the 'flu. i also got the short straw again by having to do all the frigging central lines too (big drip lines that go into big veins either deep in your neck or charming groin) and then two people decided to have cardiac arrests simultaneously (they are both ok by the way) so lots of running around. so once more i left late (not that i have a problem staying late for sick people) and what's that? oh hello there hospital management. oh really? you've done the audit and i'm working less hours than ever before? well i guess i can't disagree with your study. of course it's fine to cut my take home pay by £500 a month. no, thank you.

i was gagging for a pint but cannot do anything without having to wipe my nose every two seconds and so all hopes of beer have disappeared out the window.

i really cannot wait for christmas when incidentally i am on nights (23rd Dec to 29th Dec.)

"what did you get for christmas?"

"four new admissions."

"what did santa bring you this year?"

"nothing. santa does not bring anything for naughty boys who stay up all night."

you could not fucking make this up. you really could not.

ps. absolutely categorically NO photos. the whole point of this blog is that i remain arrogant behind a shallow veneer of anonymity (despite now having 3 mates on here)

[i am listening to ben folds, songs for silverman]

and my apartment smells of rich mahogany

2005-12-11T22:48:00.000Z

the herculean trial that was the membership of the royal college of wankers exam Part 2 is thankfully over until the imminent resit and loss of a further £290 (yes £290 - $600 for the Canadians - i know you're reading this.) i can only hope that the tossers at the college had a bloody good piss-up the night before the exams. i can only imagine the scene in the smoking room (i don't even know if they have one but i bet they do):

"i say sebastian we certainly have excelled ourselves this year!"
"ha ha! you're absolutely right charles! i think it is sheer genius that three times a year we continually set the most esoteric of questions, make sure that anyone who does not sit the exam hits a career brick wall and manage to make them pay us for the privilege!"
"ha ha! we're great we are! more champers?"
"is brucellosis rare? by the way what time do the whores get here?"
" very soon i hope. i'll get the lube! thank you junior doctors! i'm going to put this on my weblog tomorrow. ha ha!"

i did suggest that after the exam we partake in a wicker man style burning of the college but opted for the pub instead. (vegas was of course present, on a quick sojourn from the north - his blog will be darker than ever this week as the poor fella is on nights again.)

i was also pleased to hear that the american department of homeland security managed to kill someone who did not possess a bomb/was not a terrorist. a close shave. will this be another jean charles de menezes? or will it be swept under the carpet with all that illegal war/torture/insane foreign policy nonsense?
[NB. i haven't actually caught the full story on what happened there although given that it's not on any of the american news websites at the moment i imagine my gut feelings are correct. i did however read an interesting piece on paris hilton's lawn display at her home on whore island]

back to school tomorrow and that is not depressing at all.

RIP Richard Pryor

[I am listening to Bittersweet Bundle of Misery by Graham Coxon]

Your exam question for the evening

2005-12-07T22:53:00.000Z

you are called to review a 26 year old doctor in London. he is currently at a career crossroads of sorts partly due to the fact that the profession he is working in is dying a slow painful death under the weight of beaureaucracy, and, that life satisfaction is at an all time low because of the vast amount of time invested without reward in said profession. tonight he is attempting to review a series of topics for his postgraduate examination tomorrow. however fatigue is clearly setting in and you note his heavy eyelids of exhaustion as he thumbs through yet another book of practice questions. you note no rashes and he has no pets but has travelled to western canada earlier this year.

what will be the MOST appropriate way to manage this patient? (select best response from five)

A. sit down with the patient and explain to him that everyone has doubts about their direction in life at some point. this is most likely a transitory period and if in a few months he still feels this way then perhaps some time out to rejuvenate and reflect may be very beneficial. as for the exam, it is not the be all and end all and also can be sat again if necessary.

B. slap him about and kick him in the nads because he's an annoying fuck and deserves a good kicking.

C. nod sagely while he drones on with his "nah nah nah but what is the point if medical training is being sacrificed for meeting government targets nah nah nah" and see if there's anything worth nicking from his flat. hmm... 20 GB 4th gen ipod in corner... doesn't appear to work though...

D. pick up his immaculately compiled revision notes, rip them up then taking a dump on the shreds whilst saying "how do you like that bitch? how do you like that?"

E. intravenous antibiotics and urgent per rectum examination

5 minutes allocated. answers tomorrow.

[I am listening to Hope by R.E.M - formerly Leonard Cohen]

Little things

2005-12-07T08:42:00.000Z

i'm about to make my way in to tackle the beast. delightful.

at least the bus stops outside my house.

and at least the imperial war museum looks radiant in the winter sun.

[I am listening to young pilgrims by the shins whilst doing some cramming]

Some people are wankers

2005-12-04T00:36:00.000Z

i've had some troubling news. i was informed by a good friend that one of our old registrars (senior doctor) committed suicide. we'd both worked with him when we were doing surgery in our first year fresh out of med school. he was a great doctor with the driest sense of humour ever and a glowing career. we always knew he was pretty eccentric and did suffer from depression but obviously something changed over the past year or so. i don't know what and probably never will.

I won't go into the background too much. there's a slightly disparaging article from the local press here about the coroner's report. what's worse, however, is this (scroll down to nov 29th): a frivoulous piece of shit that actually makes light of the fact that he committed suicide.

i'm never one to be PC. but, to belittle and poke fun someone who obviously had severe mental health problems and then TOOK THEIR OWN LIFE is a pretty cheap shot.

needless to say my mate and i have written pretty terse emails to the author of the article. i might post my email on here later.

let me know if you think i'm overreacting. i don't think i am.

on a somewhat brighter note, another good friend has also joined blogdom. you can see his site here, also continuing the white on black colour theme that is slowly becoming the watermark of disillusioned medical blogs. go see the confessions of a venial sinner.

[i am listening to arethra franklin, say a little prayer for you]

Flunking

2005-11-28T23:33:00.000Z

i am rapidly failing this exam. 10 days to go and i still have loads to do, no study leave, three on calls and increasing amounts of crap at work to deal with.

i am looking at dermatology/haematology slides before going to bed, reading notes on the way to/from work, doing questions when i get home, etc. i am even more drained than before.

tried to be positive at work today (monday and all) and was frustrated once again. as NO-ONE (nurses/porters/radiographers) seemed to give a shit that one of my patients (not very sick at all, routine investigation booked from friday) needed a chest x-ray i wheeled him round to the department myself, sat for fifteen minutes while he had it done and wheeled him back to the ward. because i knew that if i didn't no-one else would, no-one else would care except me and him, and at the end of the day i'd take the heat when it wasn't done. i hope all the taxpayers in this country are glad that they paid for my six years training and my current salary to be a porter.

so frustrating. i am so annoyed (not really at that - i had a good old chin-wag with the patient on the way to radiology - he's written ten novels!). grrrr. and so very tired.

thinking positively now. tomorrow i have the 8am X-ray meeting to look forward to... and then the on call till nine...

D&C may be away for a little while until after the exam (next weds/thurs)

[i am listening to Only You by the Flying Pickets]

The road less travelled

2005-11-21T23:40:00.000Z

apologies firstly for the lack of communication. i was recuperating following the trials of the course and yet another weekend on call. i was so busy doing the course that i didn't really have time to let the horrible belly aching anticipation of a weekend set in. and when it came round to it, it was quick and relatively painless (though not for my patient who needed a chest drain - think of a hosepipe plunged into the chest wall and you're not far off. ouch.)

tonight i struggled to get much studying done so instead opted at about 10pm to go meet a guy i grew up with. he was meeting some other friends for a beer and asked me to come along as it was local. he's moving abroad in three weeks and i probably won't see him for some time so i thought now was as good as any night.

it was weird. our lives have diverged so much. we used to spend all our time together from about 5 to 15 years old. but i don't think we could be any different. it was still a good laugh. but... strange. i'm not exactly sure how to describe the feeling. it just didn't seem natural, like when i'm around my friends now, which is all the more peculiar as we have more history than people i know now and regard as my closest.

he was saying at one point (a little intoxicated - he'd been in the pub some time) that he was jealous of me which came as a real surprise and i did feel a little uncomfortable. i suppose it comes down to frames of reference. he has no concept of how difficult i'm finding things at the moment (though let's make it clear my life is no homeless in quake ridden pakistan or bombed baghdad) but to be fair i have no idea of what his life is like. not really anyway. i was struck by how unsure of himself he was despite his essex swagger and gift of the gab (i have inadvertantly given away my background...) and thought underlying all the gags and banter we had that there was this tinge of melancholy. i don't know really. as i said our lives have really gone in different ways.

i wonder what will happen to him when he leaves the country. he's going to canada to live with his fiancee. i hope he'll be happy and i wish him all the best.

will i see him again? honestly? probably not. we are so different now. and although i know that, it makes me very sad. when you're tiny you think that now is forever. it's only later that you realise how transient moments actually are.

will stop now as things are getting too dark! i did see a dog to day wearing a little red jumper which made me laugh. as if he said "hmmm what shall i put on this morning? i know! something bright as it's so miserable outside!"

[i am falling asleep to staralfur by sigur ros]

who's got a gun?

2005-11-15T23:38:00.000Z

my ipod has just died.

this stupid picture of a sad face has just come up on the screen and i have spent the past two hours doing all the bollocks that apple suggest on their website.

i am actually going to have to kill myself.

time for bed before i have a stroke.

[i am listening to The Promise by When In Rome but obviously on the computer and NOT on my ipod]

The Fall

2005-11-14T23:25:00.000Z

no, this is not my equivalent of "Despair" on Nip/Fuct (he's ok by the way) but actually a reference to it officially being autumn!

i LOVE this time of year! it's really cold but it's bright and sunny, the leaves are crunchy on the ground and everyone seems so cosy in their hats, gloves and scarves. well, as cosy as you can get on the tube at rush hour.

and as you can tell i survived my week of nights. the last night was horrifically busy and i had a very ill man indeed. he had suddenly deteriorated about an hour into my shift to what we call peri-arrest (about to arrest ie. stop breathing/heart stops/both.) there were a lot of hairy moments overnight but we managed to keep him this side of alive and in the morning he was much better, sitting up, off his oxygen mask and asking for breakfast. i was pretty happy and left work feeling content. that's the first time that i've felt like that in ages.

i've spent the weekend enjoying myself. no studying, no medicine, just some fun times (and sleeping). got to see some old friends, some of whom had lots of news (i tink you know who you are) and there was of course the England game. what an awesome match! though i have overdone the beer. lucky...

i am now off work till friday (when i work the weekend again) but at a course. it's funny sitting in a lecture theatre again and it's a little irritating being surrounded by annoying doctors who ask inappropriate questions of the lecturers.

"oh yes. i have a question. no over here. look at me. it's got nothing to do with your talk and isn't going to benefit anyone else in here - in fact it's going to have dubious benefit for me but i'm still going to ask it because frankly isn't the sound of my voice great? look at me. me baby."

it's in the middle of town, in an area where several university colleges are clustered. i was looking around at all these 18/19 year old freshers (not in a pervy way - well maybe for a few minutes) coming in and out of all these grand old historic buildings and was wondering what it would have been like to go to college round there, instead of having spent my uni years around hospitals.

i'm quite upset by all the trouble in France. (not putting a link as it's on the front page of everything) so much of the media seems to concentrate on putting the blame on someone/something (eg. ineffectual measures by successive governments to address their most impoverished, ghetto-ised communities) without coming up with any solutions. and as much as we'd like to think we're cultures apart from the French, from a social structure frame of reference a lot of British cities are VERY similar. you only have to take a walk around my hospital's catchment area to see that. there is undeniably tension.

all of which means i am SO disinterested in the Tory leadership campaigns of the two davids. they should both be put on lithium (perhaps they could get Patricia Hewitt some too. just a thought.) i am pleased that (Dr) Liam Fox is out because he's quite quite toxic (as one of my lecturers once said) and feel the same of Kenneth Clarke. that tosser has already screwed up the NHS once as health secretary AND he's deputy chairman of British American Tobacco. Blatant hypocrisy? Fucking nuts more like.

finally i am excited because firstly someone i have missed immensely over the past two months comes back to london next week. hooray.

and also another buddy of mine from across the pond is visiting just before Xmas. he has recently got married (though sadly i don't think his charming wife is coming along) and i was well chuffed to have been invited to the wedding in Sept in Vancouver. you should have a look at his record label Copperspine Records.

good times :)

[i am listening to Lovely Day by Bill Withers. awwww!]

Strange Days

2005-11-10T05:53:00.000Z

night 6 of 7

i can't sleep at the moment because although it's really quiet a) i'm not allowed to sleep and b) there isn't anywhere to sleep. well there is an on-call room but it's about seven minutes from the ward (too far in case something goes horribly wrong) and it's a bit like the place Buffalo Bill from Silence of the Lambs lives in only not as homely or fragrant.

tonight is actually the quietest it's been yet. i've still managed to make a complete five course meal out of the simple tasks i had to do this evening. sigh.

i've decided that i'm the worst judge of character ever. i've just had a long chat with one of the doctors from A&E who i always see poncing about and acting like a complete dick. he's very posh and i must admit i'm very prejudiced (hopefully my only prejudice) towards posh accents, completely irrationally. anyway, turns out he's really lovely and we had quite a good laugh. i really must stop writing people off after five seconds of exposure.

i don't know if you've been reading the papers this week but it's been completely bizarre. i am convinced that the world has gone completely utterly nuts.

obviously there's the great news that Kaiser Tony's attempt to detain people for 90 days for being brown skinned/bearded has been quashed. i'm sure he's not been the same since he had his supraventricular tachycardia ablated. bloody cardiologists.

also apparently there's a certain percentage of british children that believe that chips/fries are made from apples. un-fucking-believable.

and patricia hewitt. enough said. it appears kim-jong-tony appointed her health secretary for the sole purpose of whipping the NHS' rotting carcass a bit more. "make sure it's completely dead Pat." she of such einstein-ian proposals as giving hospital buildings constructed for NHS use to the private sector. and today she appears to have at some point gained enough credentials to become an oncology specialist [Hewitt "has left NHS toothless"]

well now the news round is over i'm going to go and copy the blood results from the computer to the blood results folder. somebody call the crazy police because i need to be arrested.

[i am listening to Pink Floyd]

I Am My Job

2005-11-07T00:46:00.000Z

one of my good buddies has just informed me that he has started his own blog. i am a little embarrassed because firstly he says that it was inspired by this one and secondly his writing is much more accomplished.

i don't think he will disagree too much if i say it's (also?) about a search for something missing.

please please go and see it here.

Resident Evil

2005-11-07T00:10:00.000Z

it's night 3 of 7 and it's going OK so far. well i've managed to get time to put this post up so it can't be too bad.

there have been lots of emergency admissions from casualty so although i've been kept busy it's been a good busy. busy looking after people as opposed to paperwork busy. again there have been some quite difficult cases, one in particular involving a 20-something guy who has really been through the wars with lots of hospital admissions. too many things to go into but suffice to say some people really do get dealt a harsh hand in this crappy life.

i'm pretty tired surprisingly as i don't usually start flaking out till night 6 or 7. i think i tried to go into this set of nights a bit more positive than normal so maybe it's that (emotional energy expenditure or something). i'm also trying to keep myself going with a technique that one of my friends suggested (Vegas who runs the Nip/Fuct blog.) he suggests psychologically splitting the week into 4 nights and 3 nights. so i've only REALLY got one more night left. hooray.

to end with i just wanted to say that i apologise if this blog is a bit too negative and "dark" (which is scarily the adjective several people have used to describe it) - it's not really meant to be. i just put down a stream of consciousness when i start typing. yes there's a lot of frustration but honestly i am still quite cheery in real life! a lot of people who haven't seen me since i started MOADD (have you caught on to my insistence of using that acronym?) are quite surprised when they actually speak to me and find me the same as i've always been. not the jaded, scowling, anaemic cynic they expect.

i would also hate anyone to think that i go to my patients and say:

"how are you today sir? not so good? well you should see the shit i've been doing and how crap this day has been. so yeah why don't you take these antibiotics and get yourself and your pneumonia out of my fucking face."

not all of them anyway. only the ones that have hurt people.

so, for the record, i am not severely depressed. (that can change, however, as i have just seen the football scores.)

and just to prove i am not entering a dark dark place, here is a story from the onion about a big doggy to warm you to the cockles of your hearts and maybe to below your cockles, to the sub-cockular area. (points if you post the song title and singer in comments)

http://www.theonion.com/content/node/29848

[i am listening to Robbie Williams because i can't get another station on the radio in the office]

Night Fever

2005-11-04T18:03:00.000Z

what's that?

it's november 4th 2005? really?

well that can mean only one thing...

it's time for a week of nights.

yes that 6 weekly funfest of rocking into work when everyone else has gone home to sort out all the crap that should have been done during the day, and pacing the spooky corridors at 3am trying to find a coke machine that works, has returned.

i'm sure i shall be informing you of how it goes (why are you holding your head in your hands like that?)

in other news:

had a good day yesterday! got into work to start the usual "copy the blood results from the computer which isn't working into the bleeding blood results folder because the printer doesn't work," when i was asked by one of the registrars (the one that i did my last weekend with) if i could go and help her with a sick patient on another ward. well i wasn't going to say "no sorry i'd rather sit here with all this paper" so off we toddled.

turned out he was bloody unwell and needed lots of stuff doing to sort him out. so one hairy transfer to our HDU (high dependency unit) and one central line (like a big drip line but one that goes into one of the more massive veins in your groin or neck) later he was "stable". poor guy though. i don't think he will do very well. he's about 80 and not in very good nick in general, exceptionally friendly (we'd often talk about our common support of a certain premiership football team which shall remain undisclosed in case i lose readers) and with a very supportive wife. because he's got so many other medical problems the amount of medical intervention that can be done is limited (ie. his physiology would not be able to tolerate for example general anaesthetic for an emergency operation). i always find this difficult - knowing how far to go when treating someone who is this sick. the decision is normally taken out of my hands (ie down to the consultant) and in this guy's case our management will be what is known as conservative - ie we're not going very far at all. difficult.

also went to clinic which was good. nice to have a change of scene - and get off that bloody ward. still got to do my letters from clinic... grr...

and finally: the high point of the day was that i went for a late drink with one of my old bosses from when i worked in intensive care to see if he could sort out my life. he's a decent bloke and it was good of him to take time out to listen to my woes. obviously i didn't get the elusive answers i was looking for but it was really worth getting another person's perspective, especially as that person is someone i respect and not one of the TOTAL WANKER consultants that you come across in day to day life. and then the whisky came out and conversation degenerated into decent bands, good films and toilet humour (the recipie for an awesome evening.) but i'll talk about the general "career" gist of the evening tomorrow (i see your head in your hands again.)

anyways.

off to put my flares on. it's time for some (week of) night fever.

[i am listening to Island In The Sun by Weezer]

Motivation

2005-11-01T12:54:00.000Z

things are pretty low today for no good reason. i'm off sick with some vague gastro symptoms. (somatosization? depression? lazy bastard?) would normally feel a bit guilty for going off sick (despite the fact that i've taken maybe 1 day off every 2 years for sick leave) but anyway. they'll manage at work.

had a good week off. got some studying done (though not as much as i'd hoped), caught up with lots of friends (you forget how many people are around you when you never get to see them) and managed to chill out.

then back at work yesterday and it was the same old crap. running around asking people to do tests, schedule them correctly, admin, etc

oh yeah. the most ridiculous thing yesterday was trying to send a patient home (for god's sake)

one of our dialysis patients is admitted in the early hours to a liver ward (Ward 1) as it's the only place with beds
night doctor for our team goes over to see her, thinks she's fine, and makes the plan that she's got a very mild chest infection, she can have her dialysis in the morning and go home with some antibiotics if all is ok.
i go over to see her first thing. she is fine, no temperature, clinically well, bloodwork is all fine. i agree with my colleague's plan that she should go to the dialysis unit, have her dialysis and then go home.
dialysis goes fine. i see her again afterwards. she is very well and keen to go home
at 5pm i do her paperwork and say to the dialysis team that she can go home with her meds. they tell me that she has to go back to Ward 1 to be discharged.
i trudge round to Ward 1. staff there tell me that she has been moved to another ward (Ward 2) because they needed the bed and she was off the ward the whole day. i say i've done all her paperwork can you not just discharge her anyway. they say no, they've already moved her to Ward 2.
i go down to ward 2. they say they don't know who the patient is as she hasn't arrived yet. she is still on dialysis. i explain that i think she will be coming soon as she's finished dialysis but she can go home.
ward 2 staff phone up dialysis team and say why can't she be discharged from there. they reply because she is officially admitted onto Ward 1 they can't discharge her from the dialysis unit.
ward 2 then tell me that patient will have to be admitted formally before they can be discharged (ie. be assessed by a nurse, blood pressure taken etc)
i say this is a bit mad because she can BLOODY WELL GO HOME.
ward 2 say she can't go unless she's been admitted and then discharged.
i leave paperwork with ward 2 staff and decide if the only person who can go home without being admitted/discharged is me, then i am going home

thought i would get out pretty early (5.30 ish) but ended up leaving at 6.15pm. 45 mins of nothing. if she had been ill or needed my medical "expertise" in any way i would have absolutely NO PROBLEM with staying behind 45 mins, 1 hour, 3 hours or whatever. this, however, was once again a waste of my time.

i hope she got home at a reasonable hour.

[i am listening to Somebody that i used to know by Elliott Smith]

MOADD scoop: Harriet Miers is not human

2005-10-27T17:38:00.000+01:00

it was in the press today that Harriet Miers, Dubya's bessie mate from way back when, has withdrawn her position as nominee for head of the US supreme court.

as i'm sure you're all aware (being the well informed, good looking and funny people you all are) her nomination had drawn loads of heat (as robert de niro might put it in the michael mann film of the same name) because she was a bit crap in terms of upholding republican ideology and also because it smacked of wanton cronyism that she was put forward as a candidate just for being George W's buddy.

anyways, what i think is even more interesting is that George and Harriet bear a STARTLING resemblance to 1960s English stage variety double act Ray Allan and Lord Charles, previously last seen on Des O'Connor tonight... curiouser and curiouser.

[i am listening to Deceptacon by Le Tigre]

A Toxic Book

2005-10-24T19:10:00.000+01:00

i've just been in Foyles (great central london bookshop with the BEST coffee shop in london - Ray's Jazz on the first floor) and nipped into the medical to pick up some more books for my exam (see i am doing something productive with my week off...)

anyways i was at the counter when i happened upon this book called Making Sense Of Your Medical Career. now although it's actually written for medical students, i thought that maybe i should have a flick through to see where "it all went so wrong boo hoo" for me. so i did.

OH MY GOD

this is a book that actually sets out (to poor little naive medical studes) that the only way to progress in medicine is to network network network at every opportunity, kiss as much arse as possible, that you must must must publish a research paper as otherwise it's career over and, in one section (the relationships section), suggests that one should decide whether random chats with people in the corridor are actually going to benefit one's career in any way, and, that one should as much as possible try to cut out encounters that are not going to further one's ascent up the career ladder. it actually says that (my paraphrasing).

so the question that must be asked is

what fucking planet do these people come from?

the guy who wrote it isn't even a fucking doctor yet. how did he suddenly become qualified to tell people how they should run their lives?

i mean seriously - cut out chatting to people if it doesn't further your career???! what?! i did laugh out loud at a "relationships" section - i doubt that the author could ever sustain any kind of relationship except maybe with Hal, the murderous computer from 2001: a sapce oddyssey.

the cynics amongst you could say "actually mate you're the one with the fucking career crisis at the moment" and i'd say "who's round is it? i think it's yours." but joshing aside, without getting a big head, i have "achieved" everything that this book is trying to get medical students to achieve.

the thing is i did the COMPLETE OPPOSITE of everything the book preaches should be done.

networking? fuck that. would rather be having a laugh down the pub.

eliminate chit chat? fuck that too. i love my non-sensical exchanges with the bloke in the newsagent when i'm buying the paper.

as a result has my career suffered? well not by this book's yardstick. i've done well in exams, published, got a job at a "prestigious teaching hospital" and what's the secret? well i'd like to say that i tried to be a nice bloke at all times, treated people the way i would want to be treated and never looked down on anyone. instead of networking/eliminating frivolity/etc may i suggest that people try and do that. there you go, my words of wisdom. and that didn't cost you £15.99.

as for this toxic evil book (go check out the website for a kind of watch-a-car-crash reason) my advice to any medical students is don't waste your money.

i'm starting to worry more and more. if young medical students are looking at books like this and using it as their guide to life then the NHS is even more fucked that i initially feared.

the day i stop believing that you can "make it" in life without becoming a sycophantic wanker is the day i shoot myself

grrrr.... where are my antihypertensives? night night.

[listening to she fell into my arms by ed harcourt]

A week without the bleep

2005-10-24T12:13:00.000+01:00

good afternoon

i am at home, listening to some tunes and having a cup of tea.

bliss

i should of course be studying and it would be a lie to say that i haven't done anything today - i did try to work through a few questions but yawn it's so comfortable on the sofa.

oh yes. i remember i alluded to three complaints letters i had to write. well they are to...

IKEA: cunts (see below)
Ed's Diner: a really bad chain of wannabe retro American diners. popped in yesterday to the one in Soho with a friend for a cup of fucking coffee and the jumped up little shit behind the counter directed us to a cafe down the road. what kind of fucking diner doesn't let you come in for coffee? grrr.
Work: probably the most important one (i dunno if i'll actually do 1 and 2). Now you guys might realise that i'm not exactly happy at work so imagine my delight at coming home from holiday a few weeks back to be told that MY PAY HAS BEEN CUT

FUCKERS FUCKERS FUCKERS FUCKERS

yes they've cut my bloody pay. and i'm working more hours than ever before. i really can't believe it. what the hell are they playing at? so yes now i have to write a letter applying for "pay protection". legally if you've been working at the same hospital but rotating departments they can't cut your pay (according to our shitty toothless union the British Medical Association) but the NHS are complete wankers and do what they want. or pull so much paperwork in front of you that i'm sure half their staff just cut their losses as they can't be arsed to jump through 5 million hoops.

so add that to the list of reasons why i'm a disgruntled doctor.

anyway at least i'm on leave.

[listening to Teenage Riot by Sonic Youth]

When Tolstoy finally finished War and Peace...

2005-10-23T20:11:00.000+01:00

... he realised that although his toils had produced a masterpiece, it would never top my achievment of finally PUTTING UP THESE FUCKING BOOKSHELVES.

ladies and gentlemen (and i know there are people visiting this page amazingly - over 200!) i give you my new shelves.

[i am listening to kissability by sonic youth]

I am so going to bed

2005-10-15T21:41:00.000+01:00

not going to put anything on tonight as i truly am shattered. was absolute carnage today at work though i was working with good company so it was a good laugh.

anyway. i'm off for a pint. then beddy byes. sorry the past few days have been lame.

tell you what. i'm going to hold off the blog till tuesday when i have something interesting to say and... ALL THE BOOKSHELF pictures in the world.

see you soon

[just been listening to Country Honk by the Rolling Stones]

Something for the weekend

2005-10-14T23:02:00.000+01:00

I have spent precisely 4 hours awake in my own home these past two days.

I had the pleasure of doing the on call again today in the hospital. left work about 8.45pm, got home at 9.30, had something to eat and i'm now tapping away at this in bed.

it was really busy again today.

one of the doctors called in sick so there was myself and this other guy covering the ward. it was carnage. we have a lot of ill people and admitted a couple of also unwell people who needed sorting out.

and i always end up leaving at least 30min late because i feel too bad letting the night dude come on to loads of things to do. sadly though i'm beginning to think that although it might help them out:

i am not getting paid any more to spend extra time in hospital
no-one is actually going to thank me for it
i'm going to cut into my 'free' time

which is pretty selfish and all but... i dunno. it's worrying because i don't like the person i'm becoming. god - to be where i was five years ago - all wide-eyed and MUCH less jaded.

and tomorrow i have the pleasure of the weekend at work too. i hope for my sake it's better than today.

oooh yes! and then i read this

'i'm paid too much a doctor writes'

it was originally an article in the New Statesman the other week and has been picked up by the national press. this guy is a bit of a cock. everyone knows nurses don't get paid enough and should get paid a fuck load more (as should pharmacists, domestics, etc) but this guy has been working 6 weeks and with his position is unlikely to be doing nights or weekends. i would really like to see whether he thinks he deserves his money after he's been on for 7 nights straight, and each night being CONSTANTLY paged about problems that go from 'bollocks' to 'near cardiac arrest patients.'

Anyways. tomorrow i promise you can have pictures of the bookcase.

And guess what? two of my good friends are coming down for the week from monday and also from the 24th October i am on

STUDY LEAVE for a week - no work. Yoo Hoo!

Nighty night

[i am listening to Can't Stand Me Now by The Libertines]

Goodbye Morph - Hope you are happy in clay heaven

2005-10-12T22:42:00.000+01:00

as a quick post script i just wanted to pay tribute to the legend that was Morph who tragically passed/melted away today in a fire in the Aardman Animations warehouse. (Link to the news article)

a tragic loss to the entertainment industry.

there was a very moving obituary from Tony Hart in the Guardian G2 today too.

very sad *wipes tear from eye*

see you laterz

The bookshelves are up; the career is going down

2005-10-12T22:02:00.000+01:00

well to be honest today was a bit better at work. not so much of the running round organising things but actually a bit of medicine in practice.

had this very sick patient who is still sick but stable. i hope they're ok overnight. it was pretty satisfying to get her as sorted out as possible and comfortable. i guess now i can just hope for the best.

anyway i'm going to make this quick as i'm shattered after my on call...

by the way. THE SHELVES ARE UP! pictures tomorrow (can you wait?!)

[i am listening to Easy Like Sunday Morning by the Commodores]

The work of a trained medical professional

2005-10-10T20:14:00.000+01:00

anyways about today

well it was painful again. i had lots of stupid things to do. i spent about an hour in total on the telephone seeing if one lab (lab 1) in the hospital could send another lab (lab 2) in the same hospital a set of slides (slides as in to look at under the microscope). the chain of events was as follows:

doctor from different team reviewing one of our patients asks if the slides can be sent to another lab for a second opinion by another expert... fine. no probs.
i call lab 2.
they say they do not have the slides as lab 1 have not sent slides over to them yet.
i call lab 1
lab 1 says they are aware of the slides i speak of
lab 1 says they however cannot release the slides to another lab unless the person who analysed them in the first place give permission for them to do so (fair enough - confidentiality)
i call person who analysed slides to ask for permission to release. they say "no probs mate"
i call back lab 1 and tell them big man has said ok to go
they say they cannot find slides and will call me back
i hear nothing from them for one hour
i call back lab 1 who tell me that actually they did send slides to lab 2 last week.
i call back lab 2. they have no idea where slides are. didn't realise that slides had been sent. they will have a look again. they will also call me back.
i do not hear from lab 2. i call lab 2 back. they say they are still looking but it is now 4.30pm and nearly hometime so not much will be done.
i leave my number and number of doctor working overnight so they can call someone when they do find slides. they say "cheers" but they're all going home. best to call back tomorrow and see the progress.
i tell reviewing doctor (see point 1) about the chaos. he is very pleasant and thanks me profusely for trying to sort it out. i realise this has been a waste of time.

to be fair not all of my 'work' today was like this but 98% of it was calling people, ordering things on the computer, emailing lists to people, etc. so perversely i leave work at about 6.45pm thinking that i'm glad i sorted out all the little jobs (bar the slides) over today so that tomorrow the ward will run smoothly.

then it dawns on me.

i've not actually done anything that my cactus couldn't do.

there are plenty of interesting (personally, intellectually, academically) patients on the ward with quite complicated things going on with them. some are very sick and i'm always amazed by the resolve and strength of character of some people when they're ill.

i haven't had any time to talk properly to any of them about how they feel, what they're worried about, etc all the stuff that a good caring doctor should do (cliche but true)

i haven't had any time to look into detail about some of the more bizarre rare problems that you don't see normally in medicine that a few of the patients have so from a learning point of view it's also rubbish.

and i'm knackered now! i'm so tired! from doing fucking nothing productive! from pushing paper all day long! by the time i've cooked dinner it'll be bed time. bollocks.

the tragic irony of it is there are thousands of people in pakistan now in need of help.

here is the BBC's take on it today "Aid begins arriving in quake zone"

i could be doing anything out there now which would be of more use than points 1 to 15 above - like clearing rubble or fucking anything. better than moving slides about the place that's for sure.

i am starting to resent now that the bullshit that i've been doing all day has sapped physical as well as mental energy.

well i'm going as the longer i spend on the computer the less sleep i get.

see you tomoz (maybe) - i have cod fillets in the fridge tonight. yum!

[i am listening to somwhere else by razorlight]

IKEA and their bookshelves

2005-10-10T19:40:00.000+01:00

evening all

so have just got home. how was your day?

have just made myself a bloody good cup of tea and am still staring at despair at those shelves on the floor. will have to leave them another night. i am really starting to resent it. it's like an unwanted guest who rocks up and stays at your place uninvited for several days whilst at the same time eating all of your jaffa cakes.

here is a picture of the fucker. smug isn't he.

[am listening to the scientist by coldplay]

I Hate Medicine And Want To Leave

2005-10-09T15:38:00.000+01:00

so this blog - why?

ok so i work a senior house officer (a junior doctor, 2 years after graduation) in a large teaching hospital in London.

i went into medicine as a fresh faced (though not as handsome back then - i fucking age well) essex lad with hopes of "making a difference" and "helping people" even though everyone at the time said you don't really.

well 8 years later i'm hating it.

i love the subject, love the patients, love the intellectual aspect. the problem is i don't love it enough to justify spending a seventh of each year working nights/weekends/late shifts.

as each day goes by i'm resenting the fact that it takes up so much of my life. i would rather be travelling, listening/playing music, doing a job i enjoy.

i really don't know what to do. in a way i'm glad i'm being honest to myself that i'm not getting anything like as much out of it as i used to but i don't know what to do about it.

apparently i'm not alone in feeling this way.

what is it about medicine in the NHS/medicine today that is making it so unappealing? i'm getting pretty sick of defending the NHS (which i still maintain is one of the few good things left about this country) when i'm so miserable in it.

that and what to do now is the reason for me foraying into the internet. this blog is supposed to be a way of finding out why good people (hopefully me being one of them) are feeling so disillusioned working in what should be a blinding profession.

the plan

there isn't one really at the moment but here's as far as i've got:

i finish my job in august 2006
stick it out till then
get some exams (you have to do post-graduate exams to go into a speciality) as if my life goes tits up then i've got something to fall back on
take 6 months off, maybe a year
travel - South America is calling
er.......
that's it....
you should always have an even number of list points

for the record: I DO NOT WANT TO DO GENERAL PRACTICE OR GO TO AUSTRALIA/NZ - which seems to be the only advice people have.

so there you go

that's the point of this blog... vaguely.

only 14.5 hours before i have to get up for work tomorrow. that, my friends, is depressing.

coffee time

[i have been listening to the bucket by kings of leon]

Pile of crap bookcase

2005-10-09T11:36:00.000+01:00

i am hung OVER

last night degenerated somewhat. as i mentioned we were at the white hart, then baltic which is on blackfriars road before heading over to the Pit bar underneath the Old Vic. the latter is pretty good if you're in the area for a late night drink as it's open way past pub closing. fucking bizarre clientele though - a mixture of theatre-goers, luvvies and wasters. better than cubana up the road which has recently ascended completely into chav status IMHO. probably because there's so many goddamn suits in there all the time. run by doctors from tommies up the road so i hear... must be crap.

it was the bishop's leaving do (just finished his PhD in pain... of all things) and yes am feeling rough today. bloody good night though.

anyways

this bookcase is really really pissing me off. it doesn't bloody fit together. don't worry - i don't have those hampers. i haven't completely descended into an existential crisis yet. i hate ikea (the one in croydon is particularly grating).

[i have been listening to Evil by Interpol ]

Bookshelves and Snoozes

2005-10-08T18:42:00.000+01:00

so actually i've not done a lot for this blog today though i have figured out how to use it a bit better. anyways it's far too late to do anything at the moment but i promise to be less mundane tomorrow.

i have struggled with trying to put together a massive set of bookshelves and have discarded the stupid instructions with a healthy dose of disdain...

i'm off down the pub for post football chat (england are bollocks - i shall add england manager to my potential job possibilities when i leave medicine - aha! there is a clue for you about the nature of this site....)

it's the white hart in waterloo, just tucked away behind the station... a current favourite. here's a link (The White Hart in Timeout)

see you in the morning (though i'm pretty sure i'm talking to myself)

MOADD

2005-10-08T12:05:00.000+01:00

saturday! and MOADD (as i hope this blog shall be referred to on the "street") is up and running. i think i'll leave it a bit longer before i tell you why i decided set this up (stop salivating in anticipation please) so that i can actually work out how to use this properly.

will be back shortly

adios for now