Archive for May, 2011

Either Way

In preparation for my year to come I’ve been trying to work my way through Alister McGrath’s excellent Christian Theology: An Introduction, which I’d been eyeing in the MCC bookshelves for a while now.

Reading it has helped me confirm how hard I find it to feel confident in any particular theological position. Or let me re-phrase that: I find that I read about different theological positions on a certain issue and I find both positions to be eminently sensible.

Not all of them, I’m pretty sure I’m not a Donatist of Pelagian.

Is this just me as a classic fence-sitter or is it a common experience?

The art of medicine

What do we mean when we invoke the subtle and ever so nebulous “art of medicine”?

Most people consider it an essential skill and part of being a good doctor to be able to correctly apply the art of medicine in the appropriate situation.

When we invoke the art of medicine with either patients or colleagues I think it can mean one of the following:

  • we’re about to do something that the doc who sent them in; the guidelines; the evidence; the protocols, would tell us not to do
  • the evidence tells us to do two different and mutually exclusive things
  • there is no evidence to what we’re about to do
  • we don’t know what’s wrong with the patient and we’ve just made up a diagnosis
  • we’ve got bored and done this

Calling it art is perhaps appropriating more value from the word “art” than is justified. But calling it bullshit wouldn’t go down to well either.

Perhaps for emergency docs it’s more like what Jerry Hoffman means in this talk that the art in medicine (my term not his) is our ability to make decisions in the absence of information.

The willingness to make and act on decisions made in the absence of adequate information requires a certain mixture of 2 things. One perhaps more valuable than the other

  • character; in the big muscular, practised Aristotelian sense
  • balls like a bull on steroids; though I find it odd that making a call as an act of bravado can be considered a positive trait
I confess that in any given moment I’m not entirely sure which of the two facets is at work in any resus room decision I make.

The website all 4 of you have been waiting for

This is my attempt to stay engaged with my vocation while I’m on my “clinical hiatus” as I call it.

Seeing as I have the time and I’m doing the study anyhow I may as well put it out there. Though I suspect it’ll largely be derivative re-posting from LifeInTheFastLane, it’ll keep the medical rants and journal articles on one site and keep those of you who come here for the pictures of the garden and stories about my brother’s dog happy.

I’d be interested if any of the non-medics could suggest a diagnosis for the x-ray on the banner of the new site.

emergencymedicineireland.com

Better ways of being lost

Richard Lehman is one of the more lucid writers on the medical literature. What he outlines here is not confined to primary care but seems all pervasive throughout medicine.

Now in the UK, the management of diabetes, like that of several other “chronic diseases,” is governed by a one-size-fits-all model which we must obey on pain of losing part of our income. It is much easier to do useless things for people who are relatively well than hard things for people who are treatment-resistant or non-adherent. And every year the QOF must get tighter, or GPs will slacken and earn too much, which they do already. So every year, with guidance from NICE, the wise and the good and the wily sit down together and work out how far GPs should be pushed next year. And the GPs duly do more and more things for people who need them less and less. There may be a different way of doing things: pray God it comes in time to rescue what sanity and professionalism remains in our ranks

The lighthouse

T’is holiday season in our house so expect (hopefully) lots of these kind of posts. The usual photo taken at arm’s length of me standing somewhere sunny looking smug, with an ocean in the background. Like this one

Though that was a whole 2 weeks ago so I’ll try and stay more contemporary.

My charming Brother and Sister-in-law (AKA Morsies) got us a voucher for our wedding enabling us to stay in one of these places.

We chose this one.

Mainly for location. It’s way out, almost as far south as you can go. If you go straight south, you don’t really hit anything till you hit Africa.

We were staying, not in the lighthouse but in the little house to right of the idiot’s finger.

I’m sure everyone has a pair of these porcelain dogs somewhere in their history

Even more excitingly, I got a surfboard and we managed to spend 3 days in the water enjoying the surf.

I have surfed before. Though rarely successfully. I have since discovered that this was largely due to the poorly made purchase that I made in NZ. A lovely board but about 2 foot too short for me. It’s somewhere still in NZ (i think), the last I saw it I think Jason had it, and he’s in Aus now, so maybe it’s doing the rounds!

The one I have now is 8ft and is surprisingly easy to stand on.

Note how fast a shutter speed you need to catch me standing on a board

Lighthouses are of course all automatic these days. This was the view from our bedroom. One night we left the shutters open to have the beam shining in; 5 every 20 seconds or so.

The house used to be home for the last keepers of the lighthouse. Them and their 15 kids! The son still maintains the current lighthouse and house.

My Jedward hairstyle gives you an idea of the wind you have to deal with. Not a place to try spitting into the wind

The Wire

We don’t have a TV. Yes I am better than you, thanks for noticing.

I used to pretty much only watch Lost, getting a series to watch all in one go, in a pizza and beer-fueled, isolationist sit-in over 14 hours. Those were good times.

I’ve not been that tempted by many of the others on offer but the sheer number and quality has got me interested again.

Me and the Mrs have just finished all 5 series of the Wire. This time spread out over a rather civilised 3 or 4 months with breaks for real life in between episodes.

It really was quite the ride.

Baltimore really is a special kind of place. I listen to a medical podcast ran by a guy working out of Baltimore and they did a piece on violence in the ED.

In Craigavon, this might mean a pissed guy putting out a window. In Baltimore it meant having police in the department and metal detectors at the entrance.

I’m a big fan of Omar. You’ve got to love the slightly perverse Robin Hood thing – stealing from the drug dealers to give to… well himself. But he had his own slightly corrupt and warped morality that contrasted nicely with continual corruption and lack of integrity every where else in the show.

Given that I gave about 60 hours of my life to watching the show I figured it deserved a mention.


Incidentally we’ve just started Boardwalk Empire.

On being older than I used to be

Liz once told me a story about someone she knows saying “back then she used to be older than me”

that made me laugh

Anyhow, I’m now older. I’ve made it to 30. Which, on my one day’s experience seems to be a lovely age. People are always very down on getting older but I still kind of like it.

I hate birthday parties, or rather I hate large amounts of attention foisted upon me when I don’t really feel like it.

Just give me your material gifts and leave your love and kindness at the door.

I usually work on my birthday which avoids all of this. I do remember Craig and Matt waiting up till  got home at 11.30pm so they could jump out in the dark and start playing Stevie Wonder’s Happy birthday song. It was moving.

This year I have a wife which is all very exciting. Having a wife is good at stopping you being a self-pitying bastard and teaches you that to love you have to let yourself be loved, you have to let yourself be celebrated.

And I did. Feel very celebrated that is.

yet another coney island blog…

Having been almost a year since I’d camped in Coney it was time for a trip back. This time, instead of the stag party I had my lovely wife in tow.

She still had to paddle her own way their mind you, this is no punting on the Cam you know…

The weather was spiffing shall we say

Being early in the season the flies were somewhat of a problem, perhaps more to one of us than the other

We didn’t quite have the island to ourselves, as there were a few boats of merry-makers tied up at the pier. The merry-making was fine, the pumping tunes from Cool FM were less in keeping with the context. They left eventually

We made camp a bit further inland amongst the bluebells.

I must confess, it wasn’t my best BBQ, we spent more time trying to keep the damn thing alight.

Good to be back camping. Here’s to a few more

Welcome to the working week

My time here is over for a while. Till September at least and then they’re taking me back for another 8 months for more anatomy teaching. Me teaching them I hope…

I’ll also be moonlighting at this

So between now and then I’m gloriously unemployed.

Well not exactly. I’ll be heading back north to work at my old shop in Craigavon.

I’ve missed the work I must say. The anatomy stuff was/is a lot of fun. You learn a lot and teaching is a lot of fun, but now it’s over I find myself getting a little bit restless and needing a bit of a challenge.

Dealing with patients is good for you. In the way that being amongst people is good for you. People are good for you because it’s hard bloody work. Good, hard, bloody work.

In emergency depts. the work is often literally, good, hard, bloody work.

Stanley tells me that medicine is a moral act. I’m inclined to agree with him. Moral acts require virtue (at least that’s my take from reading the first half of this) and medicine has certainly been morally formational for me.

If patients were people that I just happened to come in contact with, i could go around believing that I owed them no real duty as human beings. It would of course be untrue, but I live like that most of the time.

When I’m in a hospital as a certain professional, there exists a certain covenant (as Paul Ramsey would have termed it), a relationship that is more clearly defined and understood by both parties.

When I talk to patients if I want to practice virtue before them, it requires all kind of moral energy. Patients have a tendency to kick your sinful, selfish little ass and remind you of what it means to love people.

On most days I could do with my ass kicked in such a way.

[The photo above is the famous Vesalius one. Worth reading the link about him. There’s lots of that kind of thing on the display in the Long Room in TCD at the minute, including the skeleton of Cornelius McGrath, borrowed from our “office”. Incidentally, an 8 ft wall mount of the Vesalius hung on the wall of our dissection room, one of the many things we might not have room for in the new building on Pearse St.]

Gott mit uns

I’m in a book group, which is perfectly expected behaviour if you read this blog.

Kevin is in it, and some smart people too…

We’re reading the rather weighty A secular age, which feels a tad over my head most of the time, but it’s undeniably interesting and challenging the old brain cells.

On the day that the yanks “got him” I was reading this and thought it appropriate.

Taylor has just been talking about the modern era, and the retreat of Christendom in virtually all north Atlantic societies, and he’s trying to explain the so-called “American exception” to secularity.

America is “exceptional” because the alignment of the religous with the nation-state is seen as unproblematic. Europe is quite different where the phrase “Gott mit uns” makes everyone a little uncomfortable

Quite different is the attitude of the United States. This may be partly because they have fewer skeletons in the family closet to confront than their European cousins. But I think the answer is simpler. It is easier to be unreservedly confident in your won rightness when  you are the hegemonic power. The skeletons are there but they can be resolutely ignored…

A Secular Age

Charles Taylor

P528


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