one-way or return?

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

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

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

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

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

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

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

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

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

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

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

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

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

"so this man had fallen down?"

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

"so he had a heart attack?"

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

"and you helped him upstairs?"

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

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

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

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

__________________________________

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

__________________________________

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

fight on stage

*ssshwooop* there it goes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

_____________________

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

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

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

not pleased.

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

fine? the best laid plans?

like fuck no.

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

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

i am FUCKING LIVID.

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

dreaming of you

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

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

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

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

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

oh for a simple life.

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

burning bright

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

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

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

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

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

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

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

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

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

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

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

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

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

MRCP PACES is one of my favourite things

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

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

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

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

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

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

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

this makes me feel very lonely.

and scared.

[i am listening to Saint Simon by the Shins]

beer anyone?

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

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

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

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

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

Miss D&C was however sorely disappointed.

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

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

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

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

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

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

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

MOADD is one today!

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

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

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

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

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

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

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

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

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

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

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

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

vegas this one is largely for you.



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

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

lost doctor in holiday shocker

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

in the meantime i leave you with two links

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

i am an englishman

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

watch this and enjoy!

see you in a week



[I am listening to Ok Go! of course]

miserable sullen bastards

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

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

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

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

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

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

this aggression shall not stand.

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


[i am listening to The Concretes]

lost doctor in internet voyeur shock

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

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

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

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

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

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

posh and becks: i know how you feel.

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

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

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

the lost doctor is very disappointed.

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

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

the miscalculation

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

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

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

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

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

the memory of milk

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

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

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

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

what has happened here? who is controlling this?

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

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

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

in other news

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

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

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

when i get back from nights of course.

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

fully operational battle station

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

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

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

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

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

my foot in green park earlier this evening

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

as a reminder

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


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

no expense spared

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

last week the following appeared on several wards:

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

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

what are they? i asked around.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

in the interim i am not making any fucking fish.

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

why so mean?

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

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

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

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

roll on 30.

[i am listening to the rapture]

Gah!

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

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

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

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

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

[i am listening to the kooks]