Macklemore & Lewis

OK I know I'm a little late, but these dudes are amazing. (Pity I can't link the songs in the album individually here)

Letting Go.

Fuck, I just can't seem to let go.

Movie scene

So I started people-watching while having a meal alone in this restaurant. Three tables adjacent to mine were occupied by three middle-aged individuals - the business executive, blackberry in hand, typing out emails in between courses; the lone lady, ipad in hand, enjoying her meal in solitude, and this 50-ish male I couldn't quite place. He had headphones in during his meal (white, connected to his ipod), a tablet of some sort (an ipad, I presume), and with his rimless spectacles, checkered shirt, manicured hairless head and quiet demeanor seemed like he could be some advertising exec, or architect, or similar.
All seemed superficially at ease with having a meal alone.

And then I went to watch despicable me 2, alone.

I suppose I could get used to this, being alone, in a large city. (OK so Manchester isn't exactly large, but still)

Well I'd better start getting used to it anyway.

Sweets

So I was walking home from hospital when I was beckoned to this young man who'd obviously had a little too much to drink, sitting outside the hospital.
He said, "I just parked at ASDA (couple of miles away), my friend dropped me here, and I just visited a mate whose mum's just passed away. I've had a little too much to drink", after a pause, "would you have some spare change to buy some sweets to freshen up?"

So I gave him my packet of fisherman's friends.

A different species?

Just done two days of obs&gynae and I've experienced the following:
- A telling me how young I look/I must be a medical student*
- B asking me to write diamorphine (IM) because she couldn't do IVs
- C asking me to change an anaesthetist's prescription of IV (intravenous) fluids post-op from 1000ml of Normal Saline to Hartmann's (over 10 hours) because "pushing in that amount of salt would push the lady's BP up through the roof"**
- D urging me to do urgent investigations on a poor lady whose heart rate had gone up to 140 after struggling back from the toilet a few hours after giving birth (other observations completely unremarkable)***
- E asking me to partake in a natural delivery because I was around the ward (now I've got my mugshot stored forever in some random lady's facebook profile just because I was around when that beautiful moment**** happened - even though I hadn't done anything!!)

Wow.

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* Although looking at the faces of those labouring ladies of similar age, with their years of alcohol abuse/hardship etched onto their bodies (link between poverty and alcohol use, stress, etc etc from the time spent in public health etched firmly into my mind), I can understand why.
**Admittedly, this was an agency (ie temporary) mid-wife - and a regular mid-wife and I shared some sniggers and eye-rolling when she'd gone. Which I suppose brought some light into our dark days - she'd been due to return home at 3pm and I 5pm when it'd been 615pm.
Oh for amount of salt in a bag of 'normal saline' for non-medical readers, have a look at this. I hadn't realised there was soooooo much salt in a bag before this.
Although Hartmann's does contain a marginally lower amount of salt, in percentage terms.
***Ok she had had lost quite an amount of blood during delivery, which probably hadn't been fully replaced, so she had the right idea there. I just didn't appreciate being hurried every 5 mins to do further investigations, when I'd had a perfectly decent conversation with the patient who felt perfectly fine. And did an absolutely thorough (proper) examination (with husband present, I must emphasise).
****E was really really nice. Although I can totally empathise with men who lose interest in sex after watching a baby's birth. The lady's partner was there and rather brave, I thought. The sight is definitely not for the faint-hearted - don't believe it when they say it's beautiful - it's not. At all. Although there's something strangely moving about childbirth, I wonder if it's ingrained in us? Sort of a primitive 'lump-welling-up-in-throat-when-faced-with-extreme-agony' reflex?
Oh and after assisting in a C-section (now actually doing the violent pushing/pulling instead of just watching) as well I am seriously thinking of becoming celibate in the not-too-distant future.

So can't be a surgeon because I like my raw steak, and can't do obs&gynae because I don't intend to remain celibate for the rest of my life.

My female housemate burps like a middle-aged uncle who's just drunk two pints of beer.

Job interview.

Just saw an interview for a barista whilst minding my own business at the corner of cafe nero today. Mind you, it was held right smack in the middle of the seating area. Manager(? - one of them at least) and interviewee dressed informally. Interesting questions re managing conflicts in workplace and service. And interesting post-interview discussions between 2 interviewers.
I guess they have nothing to hide. And nowhere private to hold the interview in, really.

New Year's Eve.

Why is Bridget Jones showing on New Year's Eve? And why am I watching it with a tub of chocolate ice cream on my own?

I still can't dance.

It's so odd, really. Found myself sitting next to this GP partner and his wife at their annual Christmas party, had an interesting conversation about their family life. Empty nest syndrome and all that. And when finally we were all chased upstairs to the dance floor I still found myself observing contentedly next to the bar, diet pepsi in hand. Well the eminently un-danceable Lady Gaga songs certainly didn't help. (Don't get me started on her, or the noise she produces)
No it's just interesting, really, how seven years here haven't changed my basic nature. (Interesting band, that)

Torn apart.

My heart.
It's just being torn apart right now.

Life.

You know the lady that I was on the good side of?

She got progressively more ill the last week I was in hospital. And passed away the day after I finished my placement.

Medicine.

So there's this old lady in the ward right now, who quite definitely has dementia, who's delirious as well right now, for which we're investigating the cause1. She's very suspicious of all the nursing staff in the ward for some reason, and think that they're trying to poison and/or harm her2. She doesn't seem to be too afraid of me though. Thinks I'm nice, apparently, and was willing to take some oral morphine for the pain that she had been having from chronic back pain.
I've heard one of the nurses mention to another that it was because I actually kneel down and speak at her level when I do talk to her, and actually do spend quite a lot of time with her.
It's interesting, this speaking at eye level business. I do it purely for practical reasons when doing odd jobs - there are only so many ways you can protect your back, you can either raise the patient to your level (which a housemate whom I shall not name does - she elevates the patients, them being on those electric beds, to about her arm's height. And remarks without a trace of irony that the poor elderly gentlemen and ladies go "whee I'm going on a journey up high") or bend down, which is particularly bad for your back when you're a junior doctor having to do multiple cannulas/take many bloods, or get a chair, which involves more trouble than it's worth. I've never noticed that I do it consciously though, it just seems more comfortable talking at a similar level, talking to, rather than at patients.
Anyway she keeps talking about knowing the "goodies from the baddies", and as I assume as she's still talking to me courteously I'm on the "good" side I can't help but be smug about the fact that I can put on a 'caring' face when I do care. Maybe it is good, being so transparent, sometimes.
I'm so glad that despite the criminal shortage of doctors on the medical wards (and I do almost mean it literally) and the overload of work I've not turned into a "baddie". Just yet.


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1Delirium, medically, is what you get when you're physically ill, when your mind goes haywire after being bombarded by too many signals from your body when things are going wrong. Which incidentally is a marker of poor prognosis (of life, in general). Which is why you do not actually want to get delirious with joy.
2Actually probably because of various reasons, including the ritual taking of observations at odd times of the night, the administering of drugs in huge trolleys that look like poison shelves, and the eerily colour-coded uniformity of the, well, nursing, uniforms. Probably not the best particularly when you're scared and they put you in a separate room because you're causing trouble for them. Oh and try to give you poisons when they're already sneaking poison into your meals and drinks.

Reflections.

If there is just one sentence (ok two) that I remember from my 4 months in psychiatry, it's this - "there are people who choose psychiatry because they like to analyse others' words. And then there's people like us, who just care."

This was in a conversation with the old age psychiatrist I was working under, when I disclosed to her I was interested in psychiatry as a career.

And then there's people like us.

Fucking psychiatrists.

This is new!

Ooh from scotland, not nigeria, this time! (try googling the number given - quite interesting actually)

--------------------------------------------------------------------------------
Royal Bank of Scotland
Tel: +447 024 092 792
Fax: +447 092 887 134
Group 36 St Andrew Square Edinburgh
Scotland EH2 2YB United Kingdom.


Attn: Beneficiary,

This message is from Her Majesty's Royal Bank of Scotland, we wish to inform you that a Diplomat
by the name of Mr. Audrey Davis, have been mandated to deliver your payment to you in your country
of residence using the diplomatic system of delivery. since we could not complete the payment of your

Compensation Benefit through a bank to bank transfer and been aware that you have pursued these funds
vigorously to be wired to your bank with a continue stop order been plced on the transfer.

The funds valued for US$2.8 (Two Million Eight Hundred Thousand United State Dollars Only) has now been
repackaged in one diplomatic boxes with you as the beneficiary of the funds following details contained
in the documents attached to the transaction, a letter of authority was signed by Mr. Michael Gerald of

the Financial Services Authority mandating the Royal Bank of Scotland to move these funds via the
diplomatic means to you in your country.

To enable the diplomat carry out the movement of this package to you without complications do contact him
now on his email: marvin.grant15@yahoo.com or his direct phone number in the United State :+1 (607) 795-7578
the diplomat is stranded at the Raleigh-Durham International Airport North Carolina and he is waiting for you
to contact him so you are required to reconfirm to him your.

details thus:

1. Full Name
2. Address where you want delivery to be made
3. Direct Telephone Numbers
4. Date of Birth
5. prefered time of visit


We also advice that you send a copy of your identification to the diplomat through his email which we have
confirmed to you. After verification of the information which the deplomat have on file, he shall contact you so
that you can make arrangements on the exact time he will be bringing your package to your residential address
or any address as mentioned by you in the process of this delivery, we do not require a post office address.

For safety reason we will advice that you keep the content of the box to your self and not to expose it to the
diplomat, and the key to the box is (Number: 2078) you are also advice to keep this key confidential.

We await your quick response to this email to enable us carry out the process of delivery.

Regards

Winter David
Executive Chairman
Diplomatic Department

Update.

Sorry my dear readers, wherever you are (erm who's in Seattle right now?), I've almost forgotten I still have a blog.

I'll just give a quick summary of what's gone on in my life from the last blog post till now.

1. Spent 4 months in surgery. Quite enjoyable, actually, quite like working with people who are straightforward, deal with things efficiently (relatively) and work really hard. Though I can't imagine myself going into surgery - I really wonder how long surgeons' wicks are, and how they cope with next to no time for family life. And really admire their dedication despite the lousy pay here even at consultant level.
And I still am reminded of the BBQ when I enter operating theatres, so it's a definite no no for me there.
Oh and most memorable thing - was in theatre helping out in a patient who had been admitted with a perforated bowel, and saw the surgeons squeeze some faeces out of some bowel they had split open. No fan involved¹ but it was oddly fascinating, even satisfying, almost like the sensation you get when you see a blister being burst.

2. Have now done almost 2 months in psychiatry. Am in what is technically known as an organic illness assessment unit in old age psychiatry, which translated simply means dealing in general with the nice granny in the corner who believes she is back in the 1960s, and if she could would dress herself to match.
Within these few weeks I've seen a former head teacher hit a flirtatious (almost to the point of lecherousness) guy with a wet floor sign, an ex chief fire safety officer lie under the table trying to fix a non-existent pipe (I think???) and (I wish I had more of them) a nice elderly woman who owed me a few hundred pounds a day just for being nice to her.
Did I mention the youngish lady who keeps repeating the few lines of Abba's Dancing Queen so often that I miss it now she's gone on leave?
Dancing queen... young and sweet, only seventeen... Don't we all wish we were seventeen once again? (No I did NOT watch that movie.)

Will blog more about dementia and what I think of it, within the next few weeks, I promise.

Will pencil it down in my notepad, anyway.




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¹Now I realise this reference might be a bit obscure for most, so let me try to explain this briefly. Our intestines are basically quite good at stretching (think sausages made in the traditional way). Rarely do they burst (perforate), but when they do, it is usually a serious matter indeed - up to 40% of people can die from it, and this from a hole say, the size of a 5 cent coin. And perforation usually doesn't occur until late on, IE it may mean that something (quite a lot of things in fact) was missed by quite a lot of people.
So although we no longer use ceiling fans in operating theatres...

Going sentimental all again.

Listening to I Am Kloot's Northern Skies, never fails to make me cry.
Remonstrating to myself the mindlessness of it all, the salty sweetness as they fall.
Rubbish I know, but just didn't want to go all mushy on you again.

Why oh why.

A patient of mine suffered from an acute alcoholic withdrawal episode yesterday. Broke his shoulder. (That was the least of his concerns) Also now diabetic - his pancreas's given up on him.
He confessed to me this morning that his wife had smuggled several beers for him on the ward over the weekend.
This guy had been admitted with pancreatitis caused by alcohol excess - 2nd time in 3 years.

Yes he could have died.

I really don't know whether to pity his poor wife, who either didn't know better, or loved him too much to say no, or to try to smack some sense into her.

I just don't know what to think, sometimes.

Sai Gang.

You know the term that was so popularly used when we were back in the army? Sai(2) gang(1)? Well I'm starting surgery next week and have been arrowed to do bowel decompression on this patient once/twice a week. What you do is you stick a tube up the poor person's arse to allow faeces to flow out, said person having difficulties emptying his bowels¹, obviously.

So, literally, sai gang.

¹Due to a long-standing medical condition - shall not bore you with the details. Or disgust you, for that matter.

Oxford Brasserie - Southampton

Horrible place - horrible service, horrible food.

Obviously what follows is a totally subjective review based on my first (and last) visit to this place.

First impression was not too negative indeed - reached the place an hour before we were expected, and were ushered in despite the staff still having their dinner in a corner of the restaurant.

I guess the downward spiral started when my dad asked for the waitress's recommendation for his starter. She didn't seem too familiar with the menu itself, but credit to her, some quick-thinking ("not a fish dish, since you're having a fish platter for your main" - then, on discovering more than half the starters eliminated, nailed down the smoked duck, perhaps her favourite dish?) saved her blushes somewhat.

Then the bread and the starters arrived. The bread was hard, and cold; the octopus salad that mum and I had ordered had bits of octopus, assorted vegetables and wedges of tomato, all soaked in oil, like a diassembled DIY model car someone had left abandoned on the porch. Interesting concept, with random flashes of inspiration (beetroot surprisingly goes well with octopus - pity they'd probably run out of it, with the meagre piece in mine) but I don't normally associate playing with food at the table as particularly flattering, to food and individuals involved.

Oh and the calamari dad eventually ordered for his starter was so salty I had to douse my pieces in the tartar sauce provided¹.

Plates eventually cleared, mains arrived. We had ordered rabbit, fish and fancy-named chicken, and they looked rather decent, if not impressive². Real pity, then, that the legs of my headless chicken were pointing ominously at me, when the chef had plainly intended otherwise³.

Small complaint, really, when compared to the atrocious taste of all our dishes.

The twin themes running through our dishes seemed to be salt and oil - someone had obviously thought that copious amounts of oil could make anything taste good, and stimulating the tastebuds in any way was good enough for most people. That was the pre-dominant complaint from my mum; dad left his dish unfinished, which says a lot, really. And my chicken - well it seemed as if the chef had thought 'exotic' influences from all over the world could somehow all fit in a dish, but failed miserably, resulting in the confused chicken drowning in its multiple personalities. Oh and the vegetables - someone had obviously failed to mix in the salt properly, sullying what could have been a highlight of the meal.

And so half the plates were still full when the mains were cleared. And still the waitress had the cheek to ask if we wanted dessert. And had the cheek to say there was no discount provided, when it clearly was stated in our brochure that we (as serviced apartment guests) were entitled to. And then when I clearly indicated my displeasure by pressing "no gratuity" in the payment machine had the audacity to ask if I was from southampton⁴.

Thinking about it, the ironic "thank you" I had said upon leaving the restaurant was perhaps lost on them.

Please, if you ever go to Oxford street in Southampton, avoid this place. (It's separate from the 'oxford restaurant' situated next door, which in contrast is a decent place with quite decent food.)
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¹No the tartar sauce wasn't particularly good. Yes it really was that bad.
²Dad's platter of fish consisted of, well, various species of fish (and "king" prawns) drenched in oil, and placed unimaginatively on a plate; my fancy chicken was laid spread-eagled on the plate and smothered in sauce; mum's dissected rabbit was placed on a rather inviting bed of mashed potato. Vegetables came in separate dishes.
³There was an oriental-style carved flower placed near where the head might have been, together with some sprigs of parsley - even an amateur like me would have figured where that might have featured on the dish.
⁴Perhaps hinting that I did not know the rules of tipping - hell yeah like I would pay for rubbish service. Oh and in case you think I'm over-reacting, she had made no attempt at idle chatter right until she asked that question, after I had paid the bill.

The Anatomy of Melancholy

If you find my posts rambling and incoherent at times, you haven't met the master. Saying that,http://www.blogger.com/img/blank.gif it is really a monumental work, worth reading - even if just a tiny selection of it. Spent a really fruitful few hours in the Wellcome library trawling through the abridged version. Probably not the most conventional way to spend part of a trip to London, but hey I did walk down to that cheap ticket office in Leicester Square, only to find that there weren't any good matinee shows on today. And this was after covering the bits of the British museum I'd missed the last time I visited. Enough walking, I think you'd agree, for a day.

Oh the reason for reading said book? It caught my eye, nestled craftily amongst the huge collection of (fake) books lining the walls of that gallery in above-mentioned museum.