Sepsis

No automatic alt text available.Today, apparently, is “National Sepsis Day”. I am not a great fan of this modern heathen practice of granting celebrity day status to various nasty things like sepsis, anorexia, HIV, self-injury, tuberculosis, haemophilia and boils on the bum. [Please check that last reference please BB -Ed]

I much prefer to wake each morning to discover that today is a festivity, or at least a solemnity concerned with matters of the World to come.

Sepsis is the commonest process by which we will all get taken down and rendered either dead or else mightily compromised. It used to be called blood-poisoning and septicaemia. It refers to a state where the body is actively waging war against some bolshy micro-organisms that are impudently squatting and multiplying in the body somewhere. A minor infection in the bladder or chest might trigger a full-on response by the body’s immune system. The collateral damage that results leads to multi-organ failure, requiring intensive care if the subject is to survive.

Here’s the really perverse thing about sepsis: The younger and healthier one is, the worse one suffers from it! This was perfectly displayed by the 2009 Flu pandemic. All of the patients worst afflicted by this bug were under 40. The explanation goes like this: The older one gets, the more slouchy and indifferent one’s immune system becomes. Picture a sleepy police station in Shiresville: When the bank vault alarm goes off, they pause to munch a doughnut before scratching and getting off their ass. They then drive slowly to the alleged crime scene. Their fitter and trimmer metropolitan counterparts meanwhile would have already summoned an armed police presence, an SAS battalion, and a few nuclear missiles for good measure.

In both cases, the alarm had been tripped by Tiddles, the bank’s moggie, arising from her nap and inadvertently setting off one of the bank’s infra-red alarms. Two responses, two very different outcomes!

Don’t get me wrong: sepsis is a killer, and the best treatment is based on SPEEDINESS. That is speed in recognition and speed in definitive treatment. I fully support the public campaign to raise awareness about sepsis, in the hope that quicker identification of the problem and quicker referral on to skilled help, will lessen its impact.

Here is a picture of Tiddles, the bank’s cat which I am sure you have all been waiting for:

Fatcat

Not all bankers are ‘fat cats’, honestly

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A Very Noisy Lawnmower

During my time in Scotland, every week or two I had to drive 50 miles or so to Golspie, to a little cottage hospital there. I would either anaesthetize a few small cases for a visiting surgeon in their tiny but well-equipped theatre, or hold my own Pain Clinic. I used to relish my visits to the Lawson Memorial Hospital (LMH) because of the warmth of their welcome, and the quality of their home-baked cakes. YUM!

The drive there was enjoyable too. Straight down the A99 from Wick via Thrumster,  Ulbster, Whaligoe, Bruan, Occumster, Lybster, Swiney, Forse to Latheron, where the road joined with the A9 from Thurso. Thence onward to Latheronwheel, Dunbeath, Berriedale, Ousdale (and Bad Bea), Navidale and Helmsdale. Phew, let me catch my breath! The preceding roads had been very up hill and down dale with intermittent views out over the North Sea with its far away and scattered oil rigs holding their bright yellow flames aloft. Inland were the big mountains of North Sutherland, made small by their distance.

From Helmsdale the road and the railroad skirted the coastline past Portgower, Lothbeg, Kintradwell, Brora, and Dunrobin before finally reaching Golspie. I cannot remember ever visiting the LMH when the sun wasn’t shining. All year round it seemed to possess a very mild climate. The hospital itself was set well back from the road and possessed a beautifully tended large lawn at the front and luscious forests to the back and sides. That lawn was where I witnessed for the one and only time, two hares trying to knock each other’s lights out. Hares are clearly very Celtic critters: Both their males and females spend a lot of their lives smacking one another in the gob.

[Can we end this preamble please? -Ed]

OK, so one winter lunchtime I had just finished dictating my clinic letters and was leaning back in my swivelling chair with my eyes half closed, enjoying a snoozle. I wasn’t asleep as far as I could be aware and could hear everything going on around me, including some insects outside the open window busying themselves amidst the unseasonable warmth. La-La-La I sang to myself, this is the jollies for me, this life, innit.

I became aware of a mechanical noise outside. It had a rotary quality to it and I grew increasingly convinced that it was just a badly maintained lawnmower mowing the lawn. Then I wondered why the heck anyone would be mowing a lawn in the depths of winter. Before I could reason about this any further, the clinic door flew open and a distraught nurse summoned me urgently out to the front of the hospital.

The Air Ambulance was plonked right there with its rotors still spinning. The crew were desperately trying to disembark their patient/payload onto a waiting trolley. A local GP, Mary, who had been covering the minor injuries clinic at LMH was the medical attendant at the scene. I offered my help.

The patient had been in transit from Wick to Raigmore to be put under the care of the Chest Physicians there. She had chronic chest disease and was suffering an exacerbation of it. During the transfer, she developed great difficulty breathing and the crew decided to land at Golspie for help. Good decision!

The patient was whooshed to the very basic resus’ room and hooked up to the available monitors. All the usual stuff got done, and the nearly dead patient regained a potential future, but remained unconscious and very poorly. I rang Raigmore and after a considerable delay, spoke to someone who advised us to take the patient ASAP to their A&E. Mary and I immediately started preparing the patient for the mercy dash. The road ambulance arrived and the patient was put upon their trolley.

Then the phone rang. A rather furious voice at the other end told me in no uncertain terms that on no account should this patient be brought to Raigmore as there were no beds. I was told to organise a transfer to St Elsewhere’s and that it was all my own problem, so there!. The unfriendly caller on the speakerphone identified himself as “Dr Sandy McBastard”.

Mary and I looked at one another and agreed in silence: We were clearly dealing with an ass-whole. We both proceeded to accompany the casualty on the hour’s rapid transit by road to Raigmore, providing intensive care en route by the seats of our pants, and we presented her very alive but totally unannounced to their A&E department. Their competent crew took over all care and Mary and I prepared to depart, happy with our accomplishment.

That was when Dr McBastard entered stage-left. He proceeded to dress Mary and me down in the most atrocious language and tone. even though he was clearly younger and less experienced than us. We generously let him have his say, and then with balletic grace, we both firmly gave him the ‘finger’ and then climbed aboard our ride back to Golspie…..

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It was at this point that I awoke from my dream, realised where I was, and reasoned where I should be, which was at home, and that I was late. As I strode out to my car I waved gratefully to my delightful GP colleague Mary and all the lovely staff at LMH.

Joe: The State Registered Drug Pusher

Please forgive me. I was just about to go down for my midday nap, but as often happens at such times, I have suffered an unconscious melding and proliferation of memories.

A distantly past song lyric came back to me from my teenager time and I felt compelled to research its source. I eventually found a YouTube link which I present a small distance below.

The song depicts a sufferer monologuing frankly to his provider of relief, Joe the barman. (Joe doesn’t speak). To cut to the chase, it all reminds me of the days when I first ran a pain clinic and first started practising as a terminal analgesist.

How can I begin to describe its gorgeousness as a song? To save you from my answer, I simply won’t do the description thing at all. Just listen to it instead! The lyrics lie below.

Say it’s alright Joe,
I need another drink
To blow on the glass so I know I’m alive

Play me a song Joe
To fill the hours till morning
Then never again will I bother you
Ooh, Build myself a tower
No way in no way out.
Then my friends can visit me
Once in a while.

Say it’s alright Joe,
I need some reassurance
You never know what you might find in the night.
Ooh I’m just a busy bee, still alive in my hive,
I’m looking for some other world
To dream out my dreams.

There were Kings who were laughing in the rain
And they told me I’d come here to lead the parade
All the colours were changing, The sky was in ruins
The lights are all shining on me and on you Oh,
Shine on……..

Say it’s alright Joe
The night will soon be over
And nothing and no one will ever know.

Open my eyes Joe
I’d like to see the daylight
The clock on the wall says it’s time to leave.
Never seen the same face twice
Never walked the same way
The little love that I have known I keep to myself.

If there’s a fire it’s asleep in my bed
I must leave it to burn till it burns itself out
Catch as you can I’m not staying here long
I’ll be coming back early or never at all

Shine on……..

 

Well Here’s Another Fine Mess…..

We were already four hours into the operation, and things were not going well. The pelvic tumour had been resected quite easily in fact, but for the last two hours, we were dealing with major intractable bleeding coming from the rich network of valveless veins that run across the front of the sacrum. The eighth unit of blood was in progress, and some fresh-frozen plasma and platelets had already been given. More was on its way by motorbike courier from the distant transfusion centre.

I had worked with this particular surgeon on many previous occasions, and we had encountered some pretty tricky scenarios together, but none as bad as this one. He was close to retirement age and was thin, gaunt, and grey-balding. I was at least 30 years his junior, plump, plethoric and piliferous.

It was by now, late in the day and all of the theatre team were getting tired and hungry and a bit glum, as there appeared no end in sight. The bleeding from deep inside the pelvis was being staunched by a large surgical pack rammed in so as to squash the veins flat against the sacrum. Standard surgical practice in this situation is to leave the packs in situ for 15-20 minutes to allow some strong clots to form, and then carefully remove the packing. With luck, the bleeder(s) will have become sealed off, and the operation can continue. Sadly, this strategy was not working. As the fifth such pack was removed, the blood welled up as before, filling the pelvic cavity like a bathtub. A new pack got put in.

At my best I am usually good humoured enough to get on with anyone, be supportive and helpful, if that is within my gift, and generally gifted with an inventive problem-solving mind that has got me out of trouble on innumerable occasions, both clinical and domestic. I was, however, not at my best that evening. My mood and mentation turned a blacker shade of dim.

During the long pauses in which we all hoped and prayed that the patient’s clotting cascade was getting down to business, it was all terribly boring. I at least had my chart to dutifully fill out, and my technician to talk with, but chatter had long since died off. The surgeon and his assistant, with arms folded, paced around in circles like polar bears trapped in a zoo enclosure. The scrub nurse nabbed the last free stool and plonked herself on it, with her hands together, as if in prayer. Somebody turned the radio on, but the news was all bad, and the music all execrable.

I have a nasty habit, when stressed, of making hurtful acerbic remarks. Thus, I spoke forth:

Well, here’s another fine mess you’ve gotten me into, STANLEY!

(I was rather proud of this, as that was, in fact, the surgeon’s given name 😉 )

Although his face was obscured by a surgical mask, it was clear from the look in and around his eyes that he was grimacing furiously back at me. I immediately regretted my unhelpful humour and suffered some inner shame for it.

It was exactly then that my memory played its little trick: I had been in this exact situation once several years before, with a younger more vigorous cutter. He was the sort who read his journals and practised a la state of the art.

“DRAWING PINS!” I exclaimed suddenly. “DRAWING PINS ARE THE SOLUTION!”

“Have you finally lost your tiny little mind, Burrito?” retorted Stanley. “No, no, no, listen!” I said. I explained how impoverished Chinese surgeons had solved this common surgical problem years before by using all that they had to hand: common finger tacks. The broad flat head and short sharp little point were perfectly suited for pushing through a venous bleeding point and into the bony sacrum behind it which would hold it securely. The pressure applied by the tack-head would suffice to stem the bleeding from the torn vein.

Stanley still disbelieved me. I urged him to send his assistant out to the nearby hospital library to use the interweb to search for the terms “pre-sacral drawing pins”. With at least 15 minutes to go before the next pack change, Stanley assented to my request. I suppose he thought there was nothing to lose. The bright-eyed junior doctor from South Asia de-gowned and raced gladly out the doors on a mission. He returned a few minutes later brandishing some sheets of paper in his hand. There in black and white was a case report from a respectable journal of surgery describing exactly what I had seen used successfully before.

Looking up from the article, Stanley addressed the Sister in charge: “I want sterilised drawing pins NOW!” She rushed out to her office, found the largest such items, rinsed them in surgical spirit to remove the dust etc., and then put them into the autoclave to render them surgically sterile. Twenty minutes later, they were handed to the scrub nurse, ready for deployment.

We still had to face the problem of how to use these little life-savers under conditions of zero visibility. I suggested that we place the patient in a severely head-down position so as to reduce the venous pressure in the pelvis. It was worth a try at least. We tipped the operating table to beyond 45 degrees. Stanley, atop a stool, slowly pulled out the pack. The bleeding point bled just enough to show its whereabouts. A tack was pushed home, plus a few more for good measure. The bleeding stopped, but we still had to test the repair. The table was levelled off and Stanley stood motionless and watched the pre-sacral area for several minutes, like a cat outside a mousehole. Not another drop of blood emerged. Hurrah!

He placed a large drain there to indicate and drain any rebleeding, tidied up and closed up in record time. He clearly had received his second wind. I woke the patient up in the Recovery ward and he/she seemed fine.

It was about 9 pm when Stanley and I walked out the hospital doors together, friends again after our little tiff. I think this video perfectly portrays our entrance into the pub across the street for a quick pie and a pint: (I am the more portly geezer).

11th September 2001

I should have written this yesterday but I was otherwise preoccupied.

The morning of that horrific happening I was driving home to be reunited with my young wife and those of our children not yet at school. I arrived in the door to be reminded by Mrs Burrito that we were expecting delivery of our new refrigerator that day. I was quite sleepy after my preceding clinical duties but still I played with my toddler and infant incumbents as best I could. Then I snoozed on the job.

I was rudely awakened by the commotion surrounding the arrival of the fridge at around 2 pm. I staggered out to the kitchen to “supervise” the workmen delivering this new piece of domestic industrial plant and their taking away of its useless predecessor. As I ushered them out the door, my spouse howled for me to see what was happening on the telly.

I went forward and witnessed the plane plunging into the building, over and over again.

Oh God, I thought I was witnessing some awful accident!

Then the second plane plunged into the other tower.

I  became terrified as I realised it was all deliberate “human” action at work! I sat glued to the set watching the repetitive news coverage over and over and over again. It became quite hypnotic.

Homely duties supervened. I had to pick up the kids from school. As I walked up the hill to there, I heard a loud rumbling from the sky and looked up. An enormous grey aircraft was coming from out of the distance, at very low altitude, straight towards my children’s school!

I fell to my knees upon the pavement, and prayed fervently: “Oh Mercy, Mercy, not my children, please no!

A few seconds passed, and so did the plane, without incident. It was an RAF Hercules training flight in the wrong place at the wrong time. I got back on my feet and continued to pick up my kids from school.

We all returned home to supper, but only the children digested it well. All credit to the terrorists that day: We adults were all thoroughly terrorised!

That strategy and tactic has a short working life though, as history since has proven.

Terrorism becomes less effective the more it is used. People become more used to it and start to laugh at it. The best defence against the devil is to laugh at the devil!

When he/she/it isn’t being taken seriously, then its power departs.

 

 

 

 

The Jesus Nut

This is quoted from a little thing I found on the internet just now:

One day, long ago and far away, I
engaged in shoptalk with a helicopter
pilot who told me a story that
fundamentally changed my perspective
on the world.
We were discussing the kinds of
things that can go wrong with a
helicopter, especially when flying over
terrain inhabited by angry people with
automatic weapons. This pilot had been
shot down twice, and each time he had
brought his damaged craft to the ground
with no significant injuries to the people
in it. He was, as are many young pilots,
confident: “No matter where you’re hit,”
he said, “there’s always something a
good pilot can do to adjust and get his
ship down and keep his people safe.” He
paused, “Except when the Jesus Nut
goes.”
The Jesus Nut, he explained, is the
nut that secures the main rotor to the
aircraft. If this nut comes off, the main
rotor detaches, the chopper drops like a
stone, and those in the helicopter “meet
Jesus.” And, the pilot added, the cause
of the Jesus Nut coming off is invariably
a human failure to check that it was
securely fastened.
I remember thinking that the pilot
was pulling my leg. “Come on,” I said,
“checking the Jesus Nut has to be the
first and last thing every crew chief and
pilot does before takeoff.”
He countered with, “What’s the first
rule in baseball? ‘Keep your eye on the
ball.’ Ever take your eye off the ball?” I
admitted I had taken my eye off the ball
more than I cared to remember.
“It’s not that people don’t realize that
something is important,” he said, “but
they get distracted, and people who are
distracted have a great capacity to forget
the stunningly obvious.” In my mind’s eye
I can still see and hear him make his
point, and I knew intuitively that he was
right. He added that, when he was in
flight training, the school commandant
made all the candidates listen to the
recording of the last transmission from a
helicopter whose pilot had not checked
the Jesus Nut before takeoff.

One of the helicopter pilots who used to ferry me around, was the first to tell me about the “Jesus nut”. His own flight instructor used to secretly carry not the nut itself, but its locking pin, an equally vital component, with him during the flying lessons. The pin prevents the nut from becoming undone due to vibration etc. At exactly the right point in the student’s training, when the student was absolutely certain that they were God’s gift to helicopter pilotry, the teacher would fish out his little treasure and show it to the young man or woman actually flying the craft.

“Hey, look what I found on the grass just before I climbed aboard” he would say with feigned smiling innocence. “Have you ever seen anything like it before?”

The pilot, still high as a kite on their mastery of the collective and cyclic controls and other complexities of controlling a rotorcraft, would glance over, recognise the offered gem, and then suddenly lose coordination of the craft as the blood drained from their head and despair filled their heart. The training ‘copter would inevitably pitch, yaw, roll and spin in consequence. The instructor calmly took over control of course: there were no crashes or headlines. It was really a very private humiliation all arranged purely for the eternal betterment of the young pilot. There’s nowt more groundbreakingly powerful than a young whippersnapper being shown for the first time their ever-present risk of mortality: their own and that of others under their care.

Safety is always first. Always. Always. Always. Before ever leaving the classroom to explore one’s future working environment, the basics of this principle are universally proclaimed. This is sadly also universally greeted with the bored youthful refrain of “Yeah yeah yeah whatevuhhh!”

I hope to return to this interesting topic in future posts.

Jesus_nut

“A nut in the hand is worth less than one on the bush!” (Apologies to any engineers and squirrels who may be reading)

 

 

 

 

For The Sake Of The Fox

red-fox2

Let’s not all go chicken, eh?

I wrote this last year, 2016.

Some years ago, while preparing an asleep patient for major bowel surgery, I blurted out “Oh, for fox sake!!” This was triggered by some hassle with the equipment I was using.

(I have a whole arsenal of euphemistic exclamations with which I avoid blasphemous or profane speech: Oh sugar! Cheese and crackers! FFS! etc.)

My surgeon colleague, a big burly and jolly Muslim from Yemen took the time to ask me why I was imploring the blessing of a fox. He genuinely wanted to know.

Speaking straight off the top of my heart, this was my reply:

Once upon a time, when this part of the world was called Christendom it was common to upbraid a falling fellow with the words “For Christ’s sake!”.

Sadly, in this post-Christian society Christ’s name has become taboo, it makes people uneasy, and so people use a vulgarity like “f**k’s” instead when they emote. I cannot abide with vulgarity in everyday speech so I use the word “fox” in its place.

Does that answer your question?

Everyone in the operating room had listened to this unexpected exchange and were moved by it. There was a short silence and then my Muslim friend smiled and nodded with understanding. He clapped me on the shoulder and laughed. “I never expected such an elegant answer”, he said.

Even in my dwindling professional capacity, I have many letters after my name. I am thinking of adding “FFS” to them as I increasingly utter those words while I battle to maintain my sanity working in the UK’s Notional Health Service.

-Dr B. Burrito BA BM BCh FRCA FFS

Stone Soup

stone

This is a typical soup stone but I don’t know which variety: Unfortunately the label has come off!

This is a retelling of an old Wisdom story. I honestly can’t claim any of the credit 😉

Once upon a time, somewhere in post-war Eastern Europe, there was a great famine in which people jealously hoarded whatever food they could find, hiding it even from their friends and neighbours.

Three soldiers trudged down a road in a strange country. They were on their way home from the wars. Besides being tired, they were hungry. In fact, they had eaten nothing for two days.

“How I would like a good dinner tonight,” said the first. “And a bed to sleep in,” added the second. “But that is impossible,” said the third. On they marched, until suddenly, ahead of them, they saw the lights of a village. “Maybe we’ll find a bite to eat and a bed to sleep in,” they thought.

Now the peasants of the place feared strangers. When they heard that three soldiers were coming down the road, they talked among themselves. “Here come three soldiers,” they said. “Soldiers are always hungry. But we have so little for ourselves.” And they hurried to hide their food. They hid the barley in haylofts, carrots under quilts, and buckets of milk down the wells. They hid all they had to eat. Then they waited.

The soldiers stopped at the first house. “Good evening to you,” they said. “Could you spare a bit of food for three hungry soldiers?” “We have no food for ourselves,” the residents lied. “It has been a poor harvest.”

The soldiers went to the next house. “Could you spare a bit of food?” they asked. “And do you have a corner where we could sleep for the night?” “Oh, no,” the man said. “We gave all we could spare to the soldiers who came before you.” “And our beds are full,” lied the woman.

At each house, the response was the same — no one had food or a place for the soldiers to stay. The peasants had very good reasons, like feeding the sick and children. The villagers stood in the street and sighed. They looked as hungry as they could.

The soldiers talked together. The first soldier called out, “Good people! We are three hungry soldiers in a strange land. We have asked you for food and you have no food. Well, we will have to make stone soup.” The peasants stared.

The soldiers asked for a big iron pot, water to fill it, and a fire to heat it. “And now, if you please, three round smooth stones.” The soldiers dropped the stones into the pot.

“Any soup needs salt and pepper,” the first soldier said, so children ran to fetch salt and pepper.

“Stones make good soup, but carrots would make it so much better,” the second soldier added. One woman said, “Why, I think I have a carrot or two!” She ran to get the carrots.

“A good stone soup should have some cabbage, but no use asking for what we don’t have!” said the third soldier. Another woman said, “I think I can probably find some cabbage,” and off she scurried.

“If only we had a bit of beef and some potatoes, this soup would be fit for a rich man’s table.” The peasants thought it over, then ran to fetch what they had hidden in their cellars. A rich man’s soup, and all from a few stones! It seemed like magic!

The soldiers said, “If only we had a bit of barley and some milk, this soup would be fit for a king!” And so the peasants managed to retrieve some barley and milk.

“The soup is ready,” said the cooks, “and all will taste it, but first we need to set the tables.” Tables and torches were set up in the square, and all sat down to eat. Some of the peasants said, “Such a great soup would be better with bread and cider,” so they brought forth the last two items and the banquet was enjoyed by all.

Never had there been such a feast. Never had the peasants tasted such delicious soup, and all made from stones! They ate and drank and danced well into the night.

The soldiers asked again if there was a loft where they might sleep for the night. “Oh, no!” said the town folk. “You wise men must have the best beds in the village!” So one soldier spent the night in the priest’s house, one in the baker’s house, and one in the mayor’s house.

In the morning, the villagers gathered to say goodbye. “Many thanks to you,” the people said, “for we shall never go hungry now that you have taught us how to make soup from stones!”

Carrion Regardless

One hot sweaty summer many years ago, the grotty old operating theatre block where I worked suffered an infestation with houseflies and bluebottles. It was of Biblical proportions, and because of health/safety and infection control worries, all operations were postponed until the problem could be addressed.

It took a while before action was taken, however as the plague was of gradual onset. The insects didn’t all turn up at once blowing trumpets! Even modern hermetically sealed theatres get visited on occasion by a lone ninja blow-fly. The sly little blighters find their way through the maze of corridors and swing doors, by tailgating staff as they go about their duties. Presumably they follow the delicious scent of surgeons operating which gets carried downwind by the powerful air stream that is always flowing through an operating suite. Once they get into the OR itself, a mild panic usually ensues. Orthopaedic surgeons who are particularly obsessed with sterility react the worst. It must be very frustrating for them encased in their sterile space-suits to be driven berserk by a tiny tormentor which they cannot even raise a hand against to swat it, for fear of becoming contaminated.

The great unscrubbed are therefore relied upon for extermination. We can’t use insecticide sprays because they can interact with some of the anaesthetic drugs, and they are too messy anyway. One solution is to turn off all the lights and then open one door. Freddie the fly usually will head for the proffered brighter future and promptly leave the room with the door being slammed behind him. Various aerosols have been tried. Surgical spirit is useless: you literally have to drown the fly before it stops kicking. If you try to spray them on the wing, they just lick their lips and soar on. Maybe they get an alcoholic kick out of it.

Plastic spray, normally used for wound dressing, has been tried. It certainly gums up their works, but the fallout and collateral damage are unacceptable: The solvent can destroy precious surfaces and you don’t want sticky residues left everywhere. I have had some success with ethyl chloride which is a very volatile liquid used to rapidly cool skin. It boils away instantly thus freezing whatever it touches. When you depress the nozzle a fine stream of clear liquid emerges with considerable force. This allows for sniping the enemy from a significant stand-off. Heat-death is instant, but this can’t be used against a moving target.

The most impressive take-down was demonstrated to me by a colleague. A particularly large and hairy specimen had survived multiple attempts on its life and was currently strolling around upside down and far above us on the theatre ceiling. From time to time it would pause and look down on us with a smug and superior expression on its face, rubbing its hands gleefully, or so I imagined. If I had ears to hear, I wouldn’t be surprised if it was blowing raspberries or yelling “Yah boo sucks” at us. The operation was on hold during all of this. My colleague nipped out to the office and returned with a big chunky rubber band. “Watch this!” he said, before stretching his weapon over his thumbnail and taking aim. 3…2…1…BANG and the bug was gone! One shot, one kill!

Gaping with amazement, I asked him where he had picked up that skill. Smiling sheepishly, he explained that while growing up in a rural tropical paradise, he had gotten plenty of practice in!

[Let’s get back to the headline topic please -Ed]

So back in the summer of Beelzebub, at first we just seemed to be experiencing a larger number of unwelcome pests than normal. The penny dropped when someone switched on the X-ray viewing screen one morning. The fluorescent tubes behind the large rectangular frosted glass panel flickered on. There then appeared the shadows of about thirty large insects running around on the inside of the screen. For all the world, they looked like they were kicking an invisible football about!

Clearly there was something seriously wrong with those theatres. Management were shown this incontrovertible evidence and credit to them, immediately suspended all operations. Engineers were sent into the plant rooms upstairs, and eventually discovered the rotting corpse of a large gull. It must have found its way in and become trapped. It then died of thirst or hunger, or perhaps loneliness-it left no note. To give it a good send-off, all the local insects of putrefaction threw a feast in its honour, and many maggots got to see the light of day. These eventually grew wings and set off in search of food. Some found their way into the wall cavity and then into the X-ray screen. Others found their way into the operating theatres below.

The dead bird was bagged up and sent to the incinerator. Every clinical area was kitted out with those electric bug zappers mounted high on the walls. The theatres began to resemble a high street butcher’s shop. From then on, the beeps, alarms, hisses and buzzes of a normal theatre were added to by an occasional fizz-bang-flash, as another one bit the dust. We were able to assure patients that their operation would be performed in a “No Fly Zone”.

Plans for a new theatre block were also set in motion, but I left that hospital long before they were realized.

 

Modified by CombineZP

“Take me to your bleeder”

(Picture: By Arjan Kop – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=61440544 )