The Higgs Bozo

After three months as a surgical houseman (FY1) for the ENT firm, I entered a completely novel environment, for me. My new boss was Mr Higgs, a general surgeon who also did urology. He was a superb surgeon: fast, decisive, and highly skilled.

Here is a video that portrays him somewhat: Mr Higgs was a Sir Lancelot Spratt sort of surgeon but a bit shorter and wearing tweeds and with a redder face. I am the hapless fellow who gives the wrong answer at the end (as portrayed by Dirk Bogarde).

Mr Higgs’ secretary was called Betty, and she remains the most nervous person I have ever met. Even at peace, her voice quivered, but in the presence of her master it quivered even to the max. Despite this nervous disposition, she adored Mr Higgs, whom she referred to titteringly as ‘H’. He refused to use new-fangled things like Dictaphones and so Betty had to follow him around everywhere and take down his every utterance in shorthand, to be typed up later.

In work he was a monster to be obeyed slavishly, but socially he was a genteel giant. When leisure permitted, he would take his junior staff off in his huge Jag’ to some expensive country eaterie and treat them to a slap-up feed and drinks galore. He had a generous soul.

He took a shine to me, perhaps because I was a bit of a hopeless case. My professional inadequacies were merely sighed at rather than bawled at. Sadly I caused him great distress on at least one occasion.

The patient required a LEFT orchidopexy. He had an undescended testicle that needed to be put into his scrotum before it became cancerous. Unfortunately, I consented him for a RIGHT orchidopexy because I was a completely incompetent doofus.

It was only after Mr Higgs made the opening incision in the wrong groin that I realised my awful mistake. “Mr Higgs”, I blubbered urgently, “I think you are operating on the wrong side!”

He stopped immediately and examined the patient’s scrotum. Indeed, the testicle in question was in the other groin. He then glowered at me with such ferocity that I wonder how I am still alive today.

After a few seconds consideration, Mr Higgs continued with the operation. Instead of opening the other groin, he managed to perform the correct operation successfully through the already open incision. Please don’t ask me how, I am only an anaesthetist..

As he delivered the last skin suture, he looked at me wearily and said: “I leave it to you to explain everything to the patient”.

What I had done, consenting a patient for surgery on the wrong side, would nowadays be termed a “Never Event”, the worst of medical sins. Fortunately, consent is now only taken from the patient by the surgeon who actually will perform the procedure, thus minimising the risk.

When I checked up on the patient the following day, he understandably wanted to know why his scar was on the wrong side.

With a lying wink, I told him that Mr Higgs liked to show off his surgical prowess occasionally. The patient, a young man, happily bought my explanation and went home, perhaps to dine out on the story for ages after.

In much later life, I met another surgeon who was just like Mr Higgs in temperament and outlook and surgical skills. He was known by his initials JLE

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An Irish Airman Foresees His Death

W. B. Yeats1865 – 1939

I know that I shall meet my fate

Somewhere among the clouds above;

Those that I fight I do not hate

Those that I guard I do not love;

My country is Kiltartan Cross,

My countrymen Kiltartan’s poor,

No likely end could bring them loss

Or leave them happier than before.

Nor law, nor duty bade me fight,

Nor public man, nor cheering crowds,

A lonely impulse of delight

Drove to this tumult in the clouds;

I balanced all, brought all to mind,

The years to come seemed waste of breath,

A waste of breath the years behind

In balance with this life, this death.

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Silent Cockpit

I recently had to raise my voice obnoxiously to quell the silly chatter in theatre at a critical moment. Better discipline would prevent this happening again.

Burrito's Stable

There is a discipline practised by those who fly aircraft, that I believe deserves to be more widely implemented, especially in critical care environments and perhaps throughout the NHS .

It is called “SILENT COCKPIT!”.

In an aviation environment, the saying of these words by ANY crew member signals that all chatter and distraction must cease immediately and everybody’s, attention must focus on the job in hand, for life is at great risk.

One of the great pleasures of working in a hospital environment is the great camaraderie enjoyed by all. There is great craic to be shared by those fighting a good fight together. The armed forces surely experience a similar thing.

Sometimes however, reality violently subverts the dolce vita.

From out of the dark without warning arises a threat to life or lives. The first to notice this may not be the leader, their second or third. It…

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Poor Boy

A sure sign you are getting older is how much time you spend reminiscing. “Nostalgia ain’t what it used to be”, is an old quote, often rejoindered by  “but then it never was”.

I first found myself humming  and singing to myself tunes I used to love as a teen and tween just the other week. The tune that stayed with me the longest was “Poor Boy” by Supertramp, from their album “Crisis? What Crisis? (1975).

Here are the lyrics, which to me are clearly a simple love song. The video follows:

Can you believe me when I say, there’s nothing I like better,
Than just to sit here and talk with you.
Although I’ll rant and I’ll rave about one thing and another
The beauty of it is so pure to me, though,
I’m a poor boy,
I can still be happy,
As long as I can feel free.

So many people I know, get old way too early
(Well are you feelin’ kind of weary?)
Just to impress you with the money they’ve made
(You better, you better change your theory)
One drop of rain, they complain, it’s the same about the wage they’re earning.

Well, that is not the way I’m gonna be,
Don’t mind the rain, don’t mind snow, don’t mind nothin’
If I know,
You will be right here with me
“Well let’s say, don’t mind your point of view,
How can we all afford to live like you;
The simple life is simply not enough,
We have appearances we must keep up”.

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-Poor Boy-
If that’s the way it’s gonna be
-Poor Boy-
It’s you for you and me for me
-Poor Boy-

I’ve tried all I can, understanding, all the fools and all their money,
When half of what they’ve got, you know they never will use,
Enough to get by, suits me fine, I don’t care if they think I’m funny.
I’m never gonna change my point of view,
Don’t mind the rain, don’t mind snow, don’t mind nothing, if I know
You will be right here with me, all the way.
Na-na-na
Don’t mind the rain, don’t mind snow, don’t mind nothing if I know
You will be right here with me…

 

Winging It

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These guys never wing it, especially if they are after your sandwich or bag of chips.

I refuse to belong to either the right or left wings of politics or anything else. For stable flight, both wings are needed, and any aeronaut, or seagull, will tell you that.

The job of politicians is to serve all those human beings who have placed all their trust in them. It is not their job to pursue some ideological crusade vicariously. SERVICE is their one and only job.

This post is no political manifesto. It is a simple statement of the principles which must underlie all matters pertaining to the running of a community, whether that be a neighbourhood, parish, town, county, or nation.

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Once upon a time, everyone was a cave-person. Life was certainly more simple then. There were no mortgages, income tax, or bills to pay. Everyday life was almost fully consumed with providing the essentials of life for the very next day, and no further. Food, water, shelter, and care for children-the vectors of the race’s future were the only priorities. Medical care was very primitive, and life expectancy was rarely beyond the age of 40. Compared with today’s modern cushy lifestyles, it was a bit grim, but it was all they had. Amazingly enough, it must have been a successful way of life, because we are all here today as a testament to our forebears in the caves.

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Wrong image: not forebears, not four bears, only two bears, duh!

“So how were all these people governed?” I hear the managers and politicians of today asking, in fear for their jobs. The simple answer is that they governed one another in a dynamically changing fashion. On Tuesday the tribe were all short of food, so the jocks would set out and bring home some mammoth for the bbq. On Wednesday, everyone fell ill and the natural healers amongst the tribe would sally forth and do what they could.

By Thursday evening, everyone’s sore guts would be getting better, but then everyone became very bored and twitchy.  Behold: the tribe’s jokers and artistes would come to the rescue. One stand-up cavemen may have stood up in front of the others and said something like this:

Some of my fellow tribes-people may think I am selfish and not compassionate, and very un-tribal,

–but that’s enough about them!

I can picture the tribe falling about laughing at the witticism.

In the background were the artistic sorts of cave-people who were busy besmirching the walls of the cave with natural pigments, for in those days, there was nothing unnatural, except laughter. They were trying to depict the rapidly evolving scene but probably failed to keep up. They could always manage a few still shots depicting this dramatic hunt or that, which would satisfy the jocks and everyone else.

At the end of the recreations, everyone would retire to their beds to sleep, except those who would tend the fire at the mouth of the cave which kept all the hostile beasties at bay.

And then there was evening and then there was morning, and the cycle resumed again.

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Oh dear, I appear to have started another thread of thought, which must be continued eventually. Alas, in my dotage, I seem better equipped for wool-gathering than spinning and weaving. Please pray for me, Thank you.

My September 11th Moment

This morning, in a moment of leisure, and under no external pressure, I firmly decided that I must retire from the NHS, ASAP.

I decided to irrevocably change my world and that of all who depend on me, in a flash.

The whys in detail will follow, but uppermost are my regrets: I will most sorely miss the pointless yearly appraisals, and the five-yearly revalidations where the State decides whether I am fit to practise as a doctor or not, above the opinions of my patients.

I will also miss trying to practise artfully in a cash starved workplace that has been mismanaged almost to the level of one of those rich corpses that float in liquid nitrogen at great expense as they await some future cure.

In no way am I fleeing from all the wonderful and beautiful people I work with, for that would be betrayal pure and simple. Besides, some of them will care for me eventually, when I succumb to nature’s processes, and then I will surely rely on their goodwill.

Simply put, I wish to retire at the top of my game. A bit early perhaps, but we can survive financially. I look forward to spending more time with Mrs Burrito and our beloved son.

[No picture or video today]

Codes

In cryptology, a code is where a certain set of symbols/characters/words means something else entirely. Examples would be the best teachers of this:

In Cockney rhyming slang, “apples and pears” means “stairs”, and a “china plate” means “mate”. This is a very easy code to break if you both share the same language and understand rhyming, but less so otherwise. Foreign language and idiom was used very successfully by the both US army Native Americans (the wind-talkers) and the Welsh infantry (the sheep-whisperers?) in actions abroad. The enemy simply couldn’t understand a word that was being spoken, and even if they could, they couldn’t get the idiom, voice of expression, or the context.

Let’s take the Welsh example further: Spotter Dai speaks over the radio to Gunner Rhodri and says “Diolch yn fawr iawn, Meurig is in the cowshed”. (Now that’s clever: using two different languages simultaneously, like most Welsh people do!)

Dai’s message actually means “Adjust azimuth by +3.5 mils and change ordinance to HEAT” (I just made that up!)

The weakness of codes is that they all have to be pre-shared, and the enemy can quickly learn them unless they are hidden by tricky languages eg like Native American and Welsh.

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I use codes with my co-workers everyday:

“Fanta” means I need more fentanyl NOW! (for the patient, of course)

“Saline popsicle” means I need one of those cellophane wrapped saline flush syringes NOW!

“Green juice” means I need reversal agent NOW! (it comes in a green box)

“Twig of life” means I need a bougie NOW!

“Roll-y roll and slide-y slide” mean we need to move the patient rapidly across from the operating table to their bed, before the poor patient wakes up half-cocked.

My assistants hear what I say, but they know what I mean. Here is a perfect musical rendition of the ideas I have just put out there. I give you Big Jim Jehosophat and Fat-Belly Jones:

Please watch it all, it is hilarious. Comedy is all code-based.

Hey There Gracie Bear!

Our daughter Grace Mary died aged nineteen months.

This picture was taken less than a week before she died.  Such is the resilience of little tots, that they can look healthy and angelic, right up to the last moment. After a five month illness, of increasing shortness of breath, and weakness, little Gracie died from a cardiomyopathy of unknown origin (‘idiopathic’).

Within the family she was known to us all as ‘Gracie Bear’. It seemed to suit her personality: she was just like a jolly little teddy bear, except when she was telling off her naughty brothers and sister before the school run! I showed her sibs a video by the Seekers from the sixties called ‘Hey there Georgie girl’, and they soon picked up the tune and modified the lyrics appropriately:

Her three older siblings were, of course, greatly distraught when she died, but in the purest and most innocent way.  They were only 9, 6 and 4, after all. She died in hospital, but the medical staff were kind and wise enough to let us take her body home with us in the ambulance. That journey was a Via Dolorosa, let me tell you. Her homecoming is burned into all our memories. That evening, I was explaining to her brother that because she had been baptised, she has gone straight to Heaven. The full moon was shining brightly through the kitchen window just then. Suddenly, he brightened up, and pointing at it, asked “Is that her, up there???” I wept. We still call it a ‘Gracie Moon’ to this day.

I now understand the meaning of ‘psychomotor retardation’, for my wife and I suffered from it for some weeks afterward. A slowing of thought, speech and movement secondary to major (reactive) depression; an inattention to self care, and loss of appetite for creature comforts. The kids didn’t have it, though. The need to look after them snapped us out of it. I was given a month off work, so we had a holiday, and this helped us all, a lot.

A picture of Gracie, waving at us from her high-chair, remains on the kitchen wall, near where she used to sit at mealtimes. We try to remember her in a non-morbid way. We visit her grave every November 1st, because we see her as the family saint.

Gracie was the last grandchild, as it happened. We took that as a signal from Heaven to have no more children ourselves. The marital relationship was recast. Life carries on.

Since that time, I have met many families with a dying child. My own experience has given me great insight into how they are dealing with it. If any reader of this post has suffered a similar tragedy, please comment and share your grief. By sharing, your burden is lessened, and your suffering is at least halved.