Archive for the 'catharsis' Category

The cost

Blogging while sleep deprived and a bit pissed off makes for good reading I expect but perhaps you say more than you meant to. I imagine this is the type of thing I’ll re tell on a comfy leather couch in about 20 years (or months depending on how it goes…)

The problem with medicine (says he, with finger pointed and all eyes watching the figure with the air of authority as he gets ready to put the world to rights…) is not neccessairily the medico-legal responsibilty.

Say that I cock up and kill someone, or miss something big or whatever – then there is a certain medico-legal responsibility that I have been negligent or incompetent and should (though not always and occasionally too often) face some kind of disciplinary action.

I figure I get paid for that kind of responsibility. That seems to be the way things work in the world, the more responsibility and education and learning you have the more you get paid. Like a top class economy crippling banker – you bring the world as we know it to an end and you still get your golden handshake…

[Although that is probably a tad unfair on the old bankers – no doubt they were unscrupulous and greedy but they were merely in the position to be so. Yes they’re bastards but I’m pretty sure we all are. Anyhow the dodgy millions they made are what paid the taxes that fund the whole NHS and now that their incomes (and tax revenues) are falling then the NHS will suffer. Anyhow it’s all a tad more complicated than a quick “bastards are bankers” “bankers are bastards” joke allows…]

Legal responsibility is one thing. Moral responsibility is a whole other kettle of fish.

You see that’s were the problem lies. I don’t give too much of a stuff about whether I’m legally responsible for a patient – fine sue me, see if i care. What I do care about is my moral responsibilty to the patient in front of me. Yes I am that self-righteously pious. It has taken years of practice believe me…

They turn up with their woes and sicknesses and it is to me they come. And me with my mythical diagnostic and healing powers, foisted upon me by a legacy of TV shows, movies and dishonest doctors, is the one that that has to give them some kind of answer and dare i say it – final solution to the whole mess. (No nazi killing reference intended…)

Do not get me wrong. I am not grumpy and moaning. I am not saying “why can’t you blood sucking parasites leave me alone and sort your own lives out and crawl into a corner and die as you best see fit”.

I enjoy the job. I enjoy that position. It is one of the highest honour and priviledges to face and speak to these people who are part scared, part hopeful, part accepting of what may lie before them.

It is the moral responsibility that I carry around with me. The simple notion that these people need sorted and that in essence is my job.

It is also what keeps me up till 3am worrying about all these little broken, sickly creatures wandering around out there in the community. It is what makes me come home and be grumpy with my house mates and my family. When you see me staring into space and grumpy and  uncommunicative I’ll either be thinking about Da or about all the patients I carry around with me in my head.

Without a doubt this is part of what makes me (i think) good at my job. It is also a large part of what makes me walk across the car park each day swearing inwardly at myself, the patients and the way we serve them.

While trying not to be too melodramatic – oh why the hell not… –  they come to me like ghosts, or apparitions, their faces, their names, their x-rays their CT scans, their veins and arteries and wounds all their weeping, worried relatives.

I have this uncanny knack of remembering every patient I’ve ever seen. Well not everyone but a scarily high proportion. I go in the cubicle and ask have i met them before then i’ll remember – you were in cubicle 4 two and a half years ago and you’d hurt your wrist and there was no fracture on the x-ray. Which is all very impressive till the patient says “oh yes but i came back a week later and the consultant said it was broken…” Which always takes me down a peg or two but I could do with that.

But i remember them all, the things we got right, the things we got wrong. Each one tells me a story.

I’m not entirely sure if all this psychotic craziness is since Da died or not. Certainly watching one of your own go through it makes you painfully aware of how important all this is. But I think I was like this to start with. Only now more so.

I sometimes I think I have a shelf-life, a period of time that I can pull this off for before it all comes crashing down around me and I end up pulling an into the wild and doing private practice as a dermatologist (awww that’s unfair on dermatologists, sorry…). I hope not.

“a man who has no memory has nothing left to hide… nothing and i like it…”

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I let you down

I’m one of the slightly grumpy bitter ones who never enjoys new year – perhaps because I tend to have a difficult time actually enjoying myself at the inevitable social occasions that go with it, or maybe it’s the compulsive happiness that i object to. Or the reinforcement of the social ideal that is implied – get trolleyed and pull a random bird to go home with – do anything but don’t be alone…

Anyhow.

Since starting work I’ve now got a wonderful excuse to avoid such revelry. I’ve managed to work 3 out of the past 4.

3 years ago – with dying nursing home patient in resus in A&E in craigavon, wondering where all the nurses had buggered off to and not looking at my watch

2 years ago – sticking tubes and lines in the lady in NZ who was too pissed to walk home and drove – into a tree

1 year ago – outside a cottage in Donegal with cigars and Bushmills, trying our best to ignore countdowns and the fact that the rest of the guys in the cottage had locked us out…

Last night – examining some woman’s manky infected toe. Poor dear.

I was not looking forward to last night’s shift – these days I’ve progressed to on-call from home overnight instead of being in on shifts but New Years Eve is normally chaos so we put extra staff on on purpose. Though i the end it was lovely and we were twiddling out thumbs at 3am wondering if maybe the credit crunch meant that people couldn’t afford to go out, get hammered and punch a window through.

I spent most of the night thinking through my latest medical mistake.

We all make mistakes, most of you reading this will know this. And mostly that’s not killing people, it’s more missing things that you could treat, and usually only missing them for a few hours till someone else notices them.

Medicine is not exactly an exact science and the luxury of time and observation usually gives you the diagnosis. unfortunately thanks to the wisdom of our government we don’t always have that in the emergency department.

None of this is excuse, none of this gets me off the fact that I missed something, but all of it put together makes all of us medics go “yeah, I’ve done that, I feel your pain…”

Yes it was busy, yes I looked at the x-rays for where i presumed the pathology would be and not looking at it as if it was a fresh slate – one of those situations where seeing the x-rays only and not the patient is actually a benefit cause it forces you to be thorough and not just look at the part of the x-ray where the swelling and bruising is… And yes it was a difficult patient who had absolutely no regard or responsibility for his own health. Yes he was hammered and that always makes everything more difficult. And yes alarm bells in my own head did go – that cautionary panic in your gut about a patient (which I have found bizarrely to be almost never wrong – i wonder how we could evidence base and audit that one…) – but still I did not listen. Still I got it wrong.

I’ll not mention what I got wrong -if you’re keen to know I can send you some interesting scans that even the non-medics could spot from across the room. The problem is not the scans, the problem was the decision to order them.

Now let it be clear that it made absolutely no difference to the patient. My gaff was picked up on the x-ray review within 2 hours of him leaving the department. We brought him back the next day and got him sorted having come to no harm whatsoever.

But still. You can’t help but take a little bit of a look at yourself. You can’t help but beat yourself up about it.

Mistakes are an inevitability of the job – this is probably my biggest in 5 years –  thankfully of no consequence, though that’s hardly the point. The point is that it happened, and it happened due to a mixture of busyness, pressure, timing, a difficult patient and most of all breaking almost all of my own rules.

Lesson learned? I hope so. Though I got away with it – and maybe one day I won’t and some poor patient will face the consequences.  Anyone have a better idea of how we do all this?

Meet Harry

Meet Harry. He’s 20. He’s got severe learning difficulties. He has epilepsy. He’s a pleasant chap. Lies in bed with his etch-a-sketch and sleeps a lot.

Harry has a broken jaw, a broken fore arm (known as a night stick fracture, like putting your arms to defend yourself), he has bruises all over his body, a bloody and swollen mess, so much so he’s lost half his blood volume into the bruises and needed transfusion. He has 4 old fractured ribs, an old fractured femur (the longest, strongest in the body), old fractures of his spine and his back is covered with whip marks from an electric cord. He has a pneumomediatsinum, a fancy term for saying his chests been battered so bad that he’s punctured his lungs.

Harry’s dad did this to him. Harry lives with his dad. Harry dad is meant to be his care giver, meant to be the one to take care of him, to look out for him.

On his wristband it doesn’t say his name as a patient. It says Mr Unknown, so that in all the computer records he appears as an unknown, so that his family can’t find him and visit him and finish the job.

Harry’s dad brought him to A&E saying he’d been having seizures all weekend and injured himself with them. He disappeared pretty quick.

First time I met him he told me he didn’t like needles and to be careful cause he needed to stay safe and would he be safe here? He told me his parents did this to him and he needed to be safe from them. He said he didn’t want to see them and he didn’t know why they did that to him. Then he cried and said again that his parents did this to him. And I sat at the table opposite and squeezed the pen I was writing with so hard that I cracked it. I stared at the page so hard as I cursed his parents very existence with all the curses I could think of.

I live in an insulated bubble where things like this don’t happen. I live in a nice, peaceful, middle class world, in a nice western country where I don’t have to see things like this.

Me and his nurse spent the next hour discussing morality and God and existence. Yeah, I’m not perfect (who is?), but I’m not that. It resonated that I’d heard this from countless alcoholics in the middle of the night in A&E, who weren’t ready to admit who they were. Who lived on a slippery slope where there’s always someone else nearer the precipice. If there’s someone you know who drinks more than you then maybe you’re ok.

I realized, in a rare and brief moment of clarity that perhaps I’m not that far away. In a different country, with different parents, with a different psychology then maybe I could have done the same. The Nazis loved their kids. We all bleed red when we’re cut.

There is a difference between an excuse and a reason. One provides the potential for pardon, the other is merely observation. I’m in no doubt of my arrogance and pride. I’m in no doubt that I fall short of what I should be. But in my head that should be over looked. Cause yeah, I’m not perfect (who is?), but I’m not that…

The Big Trip – Day 13

Mostly listening to: van morrison (live in san francisco), spin doctors (pocket full of kryptonite)
Sleeping on/in: cabin in a holiday park
KMs: 2680
Coffees: 1, plus a cup of tea i’m currently enjoying
Weather: windy, very windy. sunny
Beard up date: made a lunge for my throat this morning, so it had to go. Was definitely going ginger.

The place we stayed in last night was decent enough. A tad cold. plus the fact it only had one shower for about 25 people. We decided we’d try somewhere else. So we’re back in a cabin in a holiday park. Lovely stuff. Has a tiny fridge in it that goes ‘doyng’ every time the compressor comes on. Makes us giggle every time. Reminds me of cartoon knicker elastic snapping. Not sure what that says about me though.

Doyng…

Took a trip round the otago peninsula, which juts out from the south of dunedin. Beautiful place. Managed to visit an albatross colony (which was very windy) and 2 sea lions. The sea lions we just came across while walking across a deserted beach. Kind of a pleasant surprise. Got to within 5m or so of them and then felt bad about scaring them. Simon, i’m sure, isn’t a pretty sight to a sea lion trying to have a kip.

Went looking for penguins but with no joy. Apparently wrong time of year.

Doyng…

In the end we rolled up to one of the main surf beaches and took the kayak out on the waves. Surfers hate kayakers so we tried to stay as far as we could away from them. Plus me and si were in charming matching wetsuits and looked completely amateurish, so the further away from anyone the better.

Surf-kayaking is a recognised international sport. Si and ruth are actually friends with the world champion of surf-kayaking. He’s a biolgy teacher from norn iron. Gets to go and compete all round the world. I think it’s the way forward, become really good at a sport no one else knows about.

When I decided to (or rather ended up in by chance and default) medicine, my GP said to become a specialist. To specialise in a small area and to continue to know more and more about a certain small field. And as you specialised and you knew more and more about less and less, then eventually you’d reach the point where you knew everything about nothing.

Doyng…

The kayaking was fun. We got trashed by every wave in sight. Si kept getting whacked on the head by the kayak when he came out. Not the safest of sports. But we were kids again playing in the sea. It was cool.

Back at the cabin, we got a chinese (weird, no prawn crackers, no fried rice and lots of cabbage in the satay. What is the world coming to?), and played scrabble.

Morsies pulled out ‘stormed’ as the first play of the game, using all her letters and getting a 50 point bonus. Game over, move one.

So me and si just grumbled and moaned and tried to make out that she cheated. She ran home with a 245 point victory. Makes you sick… Made si even sicker, he’d just been beaten in table tennis by her.

Doyng… (tee hee hee…)

I used to huff something shocking when it came to scrabble as a kid. I was the youngest in the family and therefore the thickest. And I always struggled in the earlier bits of the game. And then the huffing would start. I’d sulk, cause I wasn’t getting my way, i’d play crap on purpose, and put down nothing but three letter words in a show of contempt. I remember once quitting in a huff and going and sitting in the loo and crying after one. This was not nearly as long ago as you might think.

Pride. Always pride. My ego, and my need to be right, to be better, to have attention and approval. I don’t get so upset about scrabble as I used to. I’ve moved on to bigger and better things to be a complete self-centred prick about.

If it was only scrabble then I could probably laugh at myself (the one thing the devil cannot take is to be mocked…). But now my head (and heart) sees myself as much too important to laugh at. That my petty little wants and desires are far too important to stand back and laugh at.

When I make it to where i’m going – and i’m sure I will, cause someone else is driving… Then i’m gonna spend an awful lot of the time laighing at myself. Laughing at the things I took so seriously.  At all the petty grievances that I let weigh me down. If you could only see yourself…

Doyng…

The grass is always greener

I have a small, 2m by 4m square of grass outside my flat. It’s not exactly a verdant jungle of tropical vegetation. It was some turf laid the week before I moved in. I had the high and righteous principle of not watering it cause wasting water is a waste and I didn’t want to waste money on a hose when I could easily spend it on… well whatever it is that people spend money on, I haven’t worked that out yet. And anyway I hate grass cause it’s pure aesthetic and no functionality and I felt the need to take a stand on functionality. Anyway it got sunny and the grass died and I felt bad cause it’s the owners grass and not mine and therefore guilt wins the day and I bought a hose for 4 quid and now spend a daily session watering it.

Now the grass is quite dead. It has been for some time. This isn’t one of those water your grass metaphors, that only works when you’re dry and need of refreshment – goodness this is turning into one of those dry grass metaphors. This grass is dead. The grass doctors have called time and packed up the defibrillator. All the family have come in and said goodbye. Even the funeral directors have been in to sew the lips together so the mouth doesn’t hang open. (things they don’t tell you in med school no. 478).

So watering it is doing little but make the mud a little muddier. But I like it. Just cause it’s a little time of the day to sit my bum on the kayak and think. Some would say I do far too much of that already. Some would say, me being a leading voice amongst them, that that’s what got me into this mess in the first place. Whatever that mess may be.

So I sit there and try not to look at the fat guy walking about the in his pants in the flat opposite and hope he can’t see me do the same. And I ponder life, the universe and everything. I think about my life, mainly cause I’m a self-centred (descent into swearing and needless adjectives….).

And I think a lot about catharsis. Which is a word most of us, including me, don’t really understand. It’s not the stuff you get up your nose – another C word I spell badly. I think a lot about my life and my job as being cathartic. At least I did till I looked up what it meant. Well, to be honest I still do, but I reconsidered it for a bit.

Of course where else would I turn for a definition but google. Which incidentally is what we use in work to find out stuff about diseases we (or I) don’t really understand. I have based treatment on stuff found on google. And so the first definition of cathartic that I find in the ‘Free online Dictionary’ is:

Noun: 1.cathartic – a purging medicine; stimulates evacuation of the bowels

And that kind of said it all for me. There was me thinking I could be profound and use big words and say deep stuff and then you find that. There’s definitely someone with a sense of humour up there and it ain’t me.

Thankfully, the definition continued:

Adj: 1.cathartic – emotionally purging

Somehow that was a little closer to the money. If you watch House (which I just watched four episodes in a row of, which stimulated this whole thing) then you realise that he can be a bit cathartic about the whole thing. Or just uncaring and bitter, not sure which. But that the medicine somehow keeps him going, that he vents the pain in his leg through his medical practice. Or something like that, I get confused.

I’m a bit of an adrenaline junkie. Which if I ever took up real adrenaline intravenously would lead to a brief, cold palmed and sweaty end to my life. Now I’m not the traditional sort that jumps off buildings with a pair of stretchy knickers round my ankles or driving motorbikes or eating the sausages from those ‘fresh food served daily’ cabinets in petrol stations.

I’m more of an emotional adrenaline junkie. The highs and the lows, the sweet and the sour and the bitter and the sweet. That’s why I like medicine and dealing with all types of scary stuff cause it makes me feel alive, and makes me think of more than the price of cheese or what colour to paint the dining room. I think that’s why I like being alone cause I like feeling alone and depressed and miserable. And I only enjoy these cause I’m only playing at them. I’ve never been lonely, depressed or miserable in my life. I remain the luckiest and most blessed human being on the planet and I think I just dabble in it for the experience.

The other underlying, and if it was possible, even more sinister reason that I like catharsis is that it gives me a sense of achievement, progress and yes here it comes – atonement. Which lies behind so many of my actions. That I’ve skipped past the first 11 chapters of Romans just to get to the ‘live your lives as living sacrifices… and be transformed by the renewing of your mind’ bits. Cause I love self-denial and being zen and pursuing nirvana by the elimination of the self and all that. Because it’s all so wonderfully self-centred.

So I’ve decided not to think about catharsis any more. I’ve better things to be getting on with. And now that I’m fully equipped with a working definition then I’ll have more reason to believe that most of what I think about is closer to the noun than the adjective.


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