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The British trousers the weather cannot spoil

7 Jul

There can be few things in life as sickening as the slow realisation that the chair you’ve just sat in in the nursing home was slightly damp and that someone else’s urine is now slowly soaking its way through your trousers and underwear headed towards your snuff dry thighs. You spend the rest of the day with a uriniferous odour invading your nostrils at intervals.  Is it really there?  Do I really smell like a public lavatory in late July?  Is it just my imagination?  Does the word ‘uriniferous’ really exist?

Many ‘do I smell of stale piss?’ hours later you head home desperate for a shower, a change of clothes (and a change of nursing home).  Many of us working in the caring professions will have similar contamination incidents to recall which is why I now purchase trousers impregnated with Febreze cotton-fresh and wear PVC underwear to cover all eventualities.

In recent weeks however, I’ve been able to revert to the much simpler tactic of wearing full sou’wester on sorties beyond the confines of the surgery.  Perhaps unsurprisingly, the Met’ Office inform us that we’ve had a summer that’s wetter than a Cliff Richard Christmas song and happily, waterproof clothing is now available in tweed.  The ‘fallout’ from Vera’s urinary tract infection as well as that from clouds more dark and foreboding than the prospect of compulsory attendance at a two hour fire lecture are now amply taken care of.

Our dog Jack doesn’t seem to mind the prospect of a walk in the rain which is surprising considering that he’s hairier than a female wrestler from the Ukraine and soaks up water like a giant canine microfibre cloth.  This afternoon we came home with horizontal rain blowing in our faces – me gritting my teeth and adjusting the visor on the mobility scooter and Jack happily trotting along, occasionally sniffing my trousers for some reason.  Once dried off in the porch he looks like Toyah Wilcox on a bad hair day – but that’s easily fixed after an hour with the GHD straighteners.  (I was joking about the mobility scooter).

This year, on the one hand, we’re all thoroughly disappointed with what passes for our “summer” because we feel cheated that day after day we suffer endless dark skies, wind and rain.  On the other, we’re delighted that we can commiserate with each other, moaning endlessly in the way only the British can.  And do.

Last week a patient dashed into the surgery exclaiming: “I got caught in a shower – I’m piss wet through!” Believe me – until you’ve sat in the ‘throne of urine’ in Vera’s nursing home, you have no idea what ‘piss wet through’ means.

Being a patient doesn’t come easily.

12 Apr


It’s 9.10 pm and I’m lying in bed roaring with laughter watching re-runs of Terry and June on UK Old when suddenly I notice that my heart is racing.  Surely this can only be a response to the raucous humour before me?  Whilst Terry and June continue mining comedy gold, I notice that my heart’s still beating with all the irregularity of a politician’s expenses claim. I’m not overly concerned about this because patients often complain of “palpitations” (which can mean just about anything) especially when they’re in the silence of the bedroom, he’s forgotten to take the Viagra and consequently she’s aware of no other distracting stimuli than the forceful contractions of her heart.  An ECG and a check of thyroid function is usually all that’s required coupled with much reassurance.

The following morning I’m consulting at work when my heart suddenly begins to feel like it’s leaping out of my chest.  An interesting patient problem, a fascinating diagnostic dilemma or any other pleasing alliterative anxiety, you ask?  Alas no, this is one of those: “I think my tablets might not be agreeing with me because this year’s daffodils are not what they have been” – type issues.  I begin to feel slightly faint and hurry to encourage my patient to leave by promising to stop their simvastatin if the crocuses suffer a similar paucity of efflorescence and dash upstairs for the event monitor.

Clamping the little device to my heaving bosom I record the kind of ECG trace which is so abnormal that a first year medical student wearing a blindfold would be hard pressed to miss.  I fax the trace (anonymously) through to our local Consultant Cardiologist who rings in person two minutes later (never a good sign) to enquire if it’s my heart that’s beating to the rhythm of a former Soviet state’s national anthem.  “I’ll see you at 12.30 tomorrow Nick and in the meantime if it happens again and you feel at all unwell, it’s 999.”  Terrific.

The following day I’m waiting in Cardiology when one of my own patients appears for his pacemaker check.  “I didn’t know you had heart problems doctor?” he enquires pulling out a spiral reporter’s notebook and a dictaphone ready to return to the village and publish his astonishing discovery as an exclusive in the parish magazine.  There is worse to come as I lie on the examination couch having an ECG and echocardiogram; I reluctantly accept that I have now crossed to the other side, no longer am I wearing the tweed jacket (with the pleasing coordinating tie featuring country scenes) I am stripped to the waist and covered in ultrasound jelly: I am a PATIENT.

I am shunted into another room where a technician (who is clearly delighted that she has been asked to forgo ten minutes of her lunch break – and who can blame her?) roughly shaves my chest in readiness for fitting a 48 hour ambulatory ECG.  Wielding the razor with all the finesse of a drunken sheep shearer she takes hair and a couple of millimetres of skin for good measure before reaching for the bottle of (presumably) concentrated acid to “remove any grease from your skin otherwise the pad won’t stick.”  We finish with her (quite literally) sanding down the now viciously stinging area before applying the electrodes.  Spotting the Black & Decker nail gun I wonder if she’ll go the whole hog and staple them in place but thankfully after a few cursory instructions she sends me on my way, my portable black box recording my every heartbeat.

Over the next couple of weeks the trace is analysed and I’m treated to an exercise tolerance test. I stand on the treadmill, displaying the injuries sustained from the ambulatory tracing and looking like a stigmatic on Good Friday before being treated to an ever increasing workload as the speed and slope of the treadmill are increased every few minutes.  It is negative and I breathe a sigh of relief as the consultant informs me that it’s probably been a viral infection of my pericardium triggering runs of fast atrial fibrillation.  I need no further investigation or treatment unless I fancy a trial of beta-blockers.  I don’t.

I hadn’t been especially worried if I’m honest, having suspected this diagnosis from the start, but it was sobering to be on the other side of the fence for a while.  Doctors don’t consider that they will ever make the transition to patient, we see ourselves as somehow immune from illness and disease and for the first time in years I have some insight into what it is to be the recipient rather than the donor.  I’m grateful that this potentially worrying symptom was promptly and thoroughly investigated, my only complaint being that the scars from the 48 hour monitor stayed with me for over two years and seriously dented my chances of gaining that lucrative modelling contract for Calvin Klein’s new GP country underwear range.  I suppose, under the circumstances, I should be thankful that I don’t have life-limiting heart disease (and that I managed to land the job of creative consultant on the forthcoming Terry and June The Movie).

Monday mornings and irritable GPs

23 Mar

Pulling the car into the Health Centre on Monday morning I was more than a little startled to see a queue of patients waiting to check in to my early surgery.  At least a dozen individuals were present, some of whom had been seen but a short while previously (for example I had ministered to Mrs Fenton-Wicket’s troublesome unstable angina only November last, and old John couldn’t possibly be in need of  more oxygen – why, it was surely only July that I prescribed his previous cylinder?).

I have observed on many occasions that the beginning of the week has a strange effect on the populace of Foxton Northfield (for those unacquainted with the area, our small market town lies just to the south of Upper Polyp in the shadow of the Asbestos-Plaque Hills) – perhaps a weekend’s recreation stirs something in the humors effecting a deep desire to consult with a General Practitioner before Monday morning is out?

Striding purposefully into  my consulting room I consulted the ledger revealing the morning’s list.  The stories of some of my more interesting patients I recount below (having extracted the entries I made in their medical record) – you will appreciate that for reasons of confidentiality, I have changed my clients’ names so as to render them unrecognisable:

08:10  My first of the day, Mr J Woss – emergency enema administered by Practice Nurse to remove large object from rectum – turned out to be own head.  (Nasty).

09:20  Mr G Osbourne – the man wept bitterly, almost inconsolable that his pet budgie had been received so badly last week by all but the local millionaires who had been cautiously welcoming.

09:40 Mrs E Windsor – came for travel advice since embarking upon large tour of UK towns and cities.  Obviously disappointed that a fit note annotated “work-related stress” excusing her from a trip to this year’s Royal Variety Performance was not forthcoming.  Stormed out to waiting personal train.

10:10 Mr Bryce Forsuth – requested referral for NHS wig owing to current one being terribly unrealistic.  Also had large abscess – but insisted on trying antibiotics rather than attending our local Surgical ward for incision and drainage.  Reluctantly agreed, but if not better on Monday then strictly to come for lancing.  District nurse Tess to visit Daley.

10:30  Mr Nick Cleff – 20 cigarettes per day.  Given smirking cessation advice.

10:40 Anne D Lansleigh complains of difficulty hearing of late.  It seems that despite those around resorting to ever more forceful communication, has exhibited an increasing tendency to inattention.  We can but thank God that not employed in a position of responsibility where could perhaps cause significant and irreparable harm.

Thus it was, that my morning passed with these characters interspersed with the usual questions from the worried well.  I rounded the morning off with a visit from a drug company representative, selling a novel new diabetic therapy (acupuncture using needles dipped in insulin – purely “natural”) before heading off in the afternoon to see my gastroenterologist.

 

For some time now, as regular readers will be aware, I have suffered a consortia of symptoms such as nausea, lassitude and afternoon planning meetings featuring cramps and shifting dullness.  Finally, it seems that, despite the lack of diagnostic tests available (and certainly ineffective and unrealistic management strategies) the diagnosis is clear:  I have irritable GP syndrome.

© 2012

The stories and patients referred to in this (and other) blogs are totally fictional.  This blog is intended for comedic purposes only.

Psychothyroidism – Underactivity of the clairvoyant gland

16 Mar

“My sister’s clairvoyant told me to come and see you because there’s something not right with my thyroid,” said the worried-looking patient.  I search for the smile and wait for the hearty laugh to let me know this is an elaborate joke, but alas, my worst fears are realised as it dawns on me that she’s absolutely serious.

Now I don’t spend my weekends in a caravan at the seaside  surrounded by signed pictures of Ken Dodd and The Krankies moonlighting as a palm reader, but even I could have predicted the outcome of this particular consultation. In short, there was nothing wrong with her and her bloods returned normal results. I happily broke the news a week down the line, seeking to reassure my troubled service-user who simply replied: “Well, we’ll have to keep an eye on it Doctor, because it will happen, I know it will.”

Perhaps I should be absolutely honest and tell you that I am fascinated by anything to do with psychics and mystics and magic and suggestion and I would love it to be true, but (in my humble opinion) it’s nothing more than a load of [crystal] balls.

A couple of years back we went from work to see a clairvoyant perform, sorry, my mistake: “give a demonstration” of his mentalism act, sorry my mistake again “psychic abilities” in a run down motel. We arrived half an hour before the proceedings and were met by someone doing a passable impersonation of a former member of Agadoo (remember when we all pushed pineapples and shook that tree?). Yes it was 1980s hair and spray-tan a go-go. Having had to pre-book, the four of us were carefully crossed off the list (ringing warning bells yet?) and the number ’4′ was placed next to the name.

For the next two hours (with an interval in which we were offered the fabulous opportunity to purchase his books and CDs) we were treated to: “He’s only recently passed, hasn’t he?” (to the obvious widow shaking with emotion clutching a handkerchief in one hand and a sheaf of photographs in the other), and “I’m getting June, somewhere over here” [points to whole room] “it could be a name, or a date, or it could be May?”. To be honest, I do him something of a disservice – it was both a very slick performance (for the most part) and a brilliant demonstration of the art of cold reading.

Is it fair to exploit the vulnerable like this at a time of bereavement?  Is it justifiable because it gives them comfort? Who am I to judge?  (To enter, text your answer A, B or C to 81888 – remember, entries received after death will not be counted, but may still be charged).

On the other hand, perhaps a oujia board for antibiotic requests would be helpful in a couple of years or so for those difficult consultations when Jocasta’s been sent home from prep’ school yet again with one of her highly contagious conjunctivitides. We could perhaps use it to make contact with the ghost of a once great NHS (thanks to the antics of your friend and mine Mr Lansley) to point to the word “NO” followed by “Goodbye”.

What, you’re thinking that Andy L won’t ruin your NHS?  “Well, we’ll have to keep an eye on it, because it will happen, I know it will.”  It’s written in The Star.

What should the well-dressed GP be wearing in 2012?

10 Mar

There was a time when the rural GP sported little other than three-piece tweed suits, country shirts and ties bearing pictures of pheasants.  I suppose I must admit that in my case it might be more accurate to say that there are days when I don’t.

Clothing is important to patients too – only this week a professional wrestler attended full of apologies because “I’ve come straight from work and didn’t have time to change”.  I used to joke with clients that I was an expert in fashion until I noticed that I’d started to attract the odd look of incredulity – in short, some people didn’t realise I was pulling their leg.  One eleven year-old scoffed loudly and looked at her mother as if to say: “and who exactly does he think he’s kidding?” much to the embarrassed parent’s chagrin.

So this last Sunday fortnight when Feakins, my valet, was laying out my clothes following my morning tepid bath (I favour a warm dip in the morning to start the day and a longer, hotter one of an evening for purposes of relaxation) I asked him for his thoughts on the matter.  After not inconsiderable consideration, the following week he suggested one or two changes (which we trialled) and which I am pleased to exhibit here for your delectation.

Monday

“Might I suggest, sir that we don’t startle the patients unduly and simply begin the week, with a minimal alteration?  I was thinking perhaps of a little aural adornment.”

I grant you that it was an interesting concept, and it certainly caused something of a stir – after all the addition of a little facial hair following a fortnight’s holiday two years ago is still discussed around the village and its propriety remains a topic of rapt interest at coffee mornings for those of a certain age.

Several of my more discerning clients spotted the bejewelled ear immediately – the thinly-veiled looks of disgust telling me all I needed to know.  I dispensed with the item without further delay.

Tuesday

“Perhaps a nod to modernity might be in order this morning sir?” opined Feakins vigorously brushing my vicuña overcoat from last night’s trip to the operetta.

I must confess to having felt less than comfortable today.   The reasons for this being twofold.  In the first instance, Mrs Clarke-Harris (generalised OA and recalcitrant BV) made it plain in no uncertain terms that she disapproved by telephoning our local Department of Mental Health and attempting to arrange to have me committed to an asylum – fortunately nothing came of this since the Approved Social Worker had himself been Sectioned earlier in the day and was thus unavailable.  Secondly, resisting the tremendous urge to hoist the sagging pantaloons rostrally was almost more than I could bear.  In short, it was not a happy pairing.

Wednesday

My day off (and Feakins’ too – always a trial) and lacking help from my dresser I simply opted for a pyjama day.  All went simply swimmingly until the gamekeeper insisted I accompany him to the henhouse to witness at first hand the devastation wrought the previous evening by an especially vehement fox.  The ensuing cold in my nether regions being nothing less than vexatious to my flagging spirit.

Thursday

“I regret sir, that my previous sojourns into the sartorial have caused you not inconsiderable discomfiture, but by fortuitous happenstance I came across a splendid outfit yesterday and took the liberty…”

Altogether more “me” I felt.  Indeed the day passed without incident until Mrs Templeton-Smethurst (terrible haemorrhoids – one could weep for the woman) berated me without mercy for offering her smoking cessation advice whilst being in possession of an especially fine cheroot myself.  Frankly, I fail to see the link, but there you are – and as I often impart to junior colleagues: patients can be unfathomable on occasion.  This, coupled with the somewhat embarrassing incident where the lighted cigarillo almost set fire to my remaining hair (owing to the flammability of the macassar oil) was sufficient to cause me to reconsider what had otherwise been a promising rig-out.  (Communicating my displeasure to Feakins that evening during his weekly removal of my omphalolith – look it up – I could have sworn that he hastily pocketed what looked like a letter of resignation).

Friday

Feakins said little as he wielded the pomander gently dusting my freshly-bathed and naked self with the baby powder.  Handing me my undergarments I fancied he was nothing less than furtive, his eyes staring blankly at the Italian marble floor.  Making my way through to the dressing room, I spied today’s garments freshly pressed and awaiting me on the bed.

I will not pretend that I was nothing less than relieved than that the week was drawing to an end and finally I was to be permitted to present myself to the world as I might wish.  It was true that  the plus fours resulted in a little chafing around the gatrocnemiae but in short, I was comfortable and more relaxed in this particular garb.

It has however, not been without its trials: I have not seen Feakins since and no-one in the village or on the estate seems to be able to apprise me of his whereabouts.  On the plus side however, in 2012 one does feel that this represents the image that the young General Practitioner ought to be presenting to those in his care: dependability and yet a willingness to move with the times.

Is it in the protocol, Nurse?

8 Mar

I think I should start by declaring an interest.  I like nurses and value their contribution to patient care.  They are often seen as being more approachable than us and those in their charge will sometimes volunteer  information which they would never have given up to a GP like: “I don’t like that doctor, he’s rubbish and I’m not seeing him again”.

Nurse practitioners are increasingly expanding their role, taking on diagnostic tasks and becoming prescribers (at which point they tend to stop wearing the traditional uniform and make the transition to GP-tweed and golf, and five children, and people carriers and labradors).  I think this is all to the good – our own NP is highly valued by our patients and we both possess skills and knowledge the other doesn’t so I like to think we’re a complimentary team.  She has forgotten more about contraception than I will ever know and I’m quite good at apostrophes.  (For those male collegues who might get around to reading this: contraception is those pill things some women take.  Sometimes).

Specialist nurses (such as those working in palliative care) are a tremendous resource and will often make suggestions which you’ve never considered and end up really benefiting patients.  I like to think that I’ve never been too proud to ring them for advice and take on board their suggestions – such as chocolate-flavoured laxatives – surely the future?

As a newly-qualified doctor, we found that nurses were an amazing source of wisdom and knowledge on the wards.  They knew the secrets of every consultant’s foibles and helped us satisfy their every whim.  They helped us solve clinical problems and made helpful suggestions, put fluids up when we’d forgotten to prescribe them and saved patients from our inexperienced decisions time and again.  Except Sandra.

Sandra had been a crisp-packer before making the transition to nursing and undertook her entire shift’s duties according to the protocol.  If it wasn’t in the protocol, she simply didn’t do it and telephoned one of the junior doctors instead.  I used to wonder if she had a protocol for making a cup of tea on her numerous “fag breks” or one for watching Coronation Street at home.  I first came across her when I was employed on the medical wards at the very outset of my inaugural job – she paged me for advice one evening around 8 o’clock:

“It’s Sandra on three.  Can you come and see Mr Thomas, he’s unresponsive?” she asked.

“Unresponsive?  Is he breathing, is there a pulse?” I asked, starting to worry.

“Erm, no, but it says in the protocol that you ‘ave to come and see ‘im” she said.

“Well, I think you need to put out a cardiac arrest call if he’s unresponsive and there’s no pulse.  I’ll be there as soon as I can.”  I set off running as fast as I could.  I was on the south side of the site about as far from Ward 3 as it was possible to be without being in someone else’s hospital.  My pager exploded into life: “Cardiac arrest, ward three, cardiac arrest, ward 3.”  I reached the ward gasping for breath.

“‘E’s in ‘ere” said Sandra, pointing into a side ward.  I almost fell into the room, virtually collapsing with exhaustion after my gargantuan physical effort.  There was no doubt that Mr Thomas was indeed unresponsive.  He lay under a sheet covering him from head to toe, a single carnation placed gently on his chest and a bible open on the bedside locker – the whole spectacle dimly illuminated by the soft overhead night light.

“He’s dead, isn’t he?” I asked, “you’ve even laid him out.”

“I know, but it says in the protocol that a doctor ‘as to certify ‘im, so I bleeped you.  I can’t say ‘es dead.”  As the remainder of the cardiac arrest team fell breathless onto the ward, I realised that I simply didn’t know what to say to her and so filled with incredulity I turned silently and left.

With the benefit of experience I know what I’d do now in that situation.  I’d reach for the lever arch file, sit myself down and have a good look at what to say to a nurse who asked me to urgently see a dead patient  – after all, it must be there, in the protocol.

Hospital food – it’s special.

29 Feb

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I love food.  There are those who eat to live and others who live to eat.  I am definitely in the latter category.  To me, eating is one of life’s pleasures – unless you serve me sprouts (no, I really won’t like the way you cook them, so if it’s all the same to you, I’ll just give them a miss thanks) or chilli (kidney beans should be banned).  Otherwise, I’ll eat pretty much anything – oh, except shellfish – one bad mussel as a student and the ensuing two days of vomiting was enough to put me off consuming anything still in possession of its alimentary tract for the rest of my life.  Nor do I comprehend why anyone would consider serving up anything with claws, tentacles or eyes looking back at you from the plate (it’s dreadful when someone’s watching you eat) so it’s a definite non to the fruits de mer, merci.

I’ve always had a healthy appetite and cooking has been, since learning to throw a passable lasagne together at the end of my first year at university, my one creative outlet.  I can’t draw, or paint, can barely sing and as for dancing – don’t even go there: I never do.

Imagine my excitement then, as a newly-qualified doctor at Scriventhorpe General Infirmary* in West Yorkshire  when we were presented with vouchers entitling us to a complimentary supper in the hospital canteen.  At the end of a long day consisting of more induction than a first-time mother of quads on a labour ward, we house officers retired to our on-site rooms to change into dinner suits in preparation for the impending repast.  Nonchalantly throwing my white silk scarf over my shoulder, I ambled down to the optimisitcally signed “Staff Restaurant” with my new colleagues.

Entering the refectory, which had clearly been newly decorated (in the late 1950s), and chattering excitedly, we joined the back of the queue and slowly made our way to the serving hatch.  Dressed in an off-brown tabard and sporting a nicotine-stained hairnet, Brenda (or ‘Blender’ as she came to be affectionately known – owing to the mostly liquid food she proffered daily) drew hard on her cigarette blew a plume of smoke into the extractor hood above her head and muttered: “What’ll it be luv?” with every word the bobbing cigarette (still mounted in the fissured lips) threatening to sprinkle a garnish of ash into the simmering victuals beneath.

I surveyed the rectangular stainless-steel vats of indeterminate fare before me and opted for something which looked like it might once have been part of a chicken.  “I’ll have the curry please,” I ventured.  Blender wielded her oversize slotted spoon with gusto depositing two enormous spoonfuls of food on a once-white plate before overlooking the rice, grabbing a small shovel and adding a generous portion of chips on the side.  The meal was then pushed toward me.  For a second or two, I toyed with the idea of asking for rice instead, but the end of Blender’s cigarette glowed red as she dragged in a lungful of Benson & Hedges, looked at the customer behind me and choked out: “What’ll it be luv?”

We stood there with our food and having presented our vouchers to the cashier, looked around the seating area seeking a suitable table.  I noticed a sign hanging from the ceiling which stated: “smoking area” and its counterpart on the other side of the room reading “heavy smoking area” – we opted for the former and took our seats to eat what could probably be described as the worst meal of my entire life.  Was this really to be the standard of our food for the next six months?  How would I survive?  Prisoners in the nearby Wakefield gaol were served better.  There was worse to come.

One of the perks of being part of the “on-call” team was the free meal provided to us for consumption after the evening’s entertainment covering the medical wards.  This had to be collected from the restaurant on the day and was handed over frozen solidly in a white plastic container by the ubiquitous Blender.  All the on-call meals were curries of varying strengths, all held in cryogenic stasis and all accompanied by a sad-looking naan bread complete with a sprinkling of cigarette ash.  They were to be warmed in a microwave oven until they resembled something which might offer a little more nutrition than their containers.  Some of them looked like they might contain meat (some of it quite possibly fit for human consumption) but in short, they were disgusting.

It’s odd how one’s enjoyment of a meal depends on so many things other than just the response of the taste buds.  Aroma, presentation, appearance and texture are all vitally important constituents contributing to the overall delectation of a meal and it’s true that the on-call dinner had none of these until midnight, when having had nothing to eat since breakfast (save for a few snatched Quality Street on the wards) it tasted like manna from heaven.

A couple of years back, we ate in a three Michelin-starred restaurant in London and had an astonishing feast – but even that wasn’t as satisfying as one of Blender’s boxes of frozen midnight slop.  I heard recently that the celebrity chef James Martin is campaigning to improve hospital food.  I say: do what you like James, but hands off the on-call meal.  That’s special.

*The name of the actual hospital has been changed in order to prevent embarrassment (it was Pontefract).