Critical But Stable

I wish hereby to lay claim to the invention of the phrase “critical but stable”. Here’s how it happened.

In 1990 I was one of the anaesthetics registrars at a big city teaching hospital. It was a most dysfunctional department as the professors and consultants were all permanently at war with one another. God knows why. From the junior doctors’ perspective it felt like being the children of divorcing parents, only multiplied many-fold. I had never experienced such an unhappy atmosphere at any of the hospitals I had worked at previously.

Every evening, after a day’s bathing in this emotional sewage, I would retire to my grimy hospital accommodation and stare at the ceiling until weariness overcame me and I fell into the arms of Morpheus. Occasionally, on a brighter evening I might even attempt to read a book. Somewhere in my bookcase still resides a slim paperback volume with a cigarette burn on its front cover from when I had drifted off during one of its more taxing passages. The book was “The Cloud of Unknowing”, which I had bought on impulse somewhere, thinking it must be about anaesthesia or something. Duh!

It wasn’t about unconsciousness, or subconsciousness, or even consciousness.

It was about super-consciousness: the melding of one’s mind, heart, and being with God’s! It is a classic work of spiritual literature, and one of the deepest. At that time, I was dabbling a bit with spiritual stuff, though only at the most basic amateur level.

Anyway, I digress. One day in early Summer I think, I was on 24 hour duty for the intensive care unit when I was summoned urgently to attend A&E. A patient had arrived from the local prison, who had hanged himself using strips torn from his bed sheet. His heart still beated, thanks to the basic life support afforded him by his warders, but he was in the deepest possible coma. I performed the needful and then took him up to ITU, intubated and ventilated. No sedation was necessary as he was already insensate.

We were accompanied at all times by prison warders who clinked with chains and handcuffs and keys as they sauntered along. The prisoner, I learned, was serving a full life sentence, for killing a cop. He was a very special guest of Her Majesty’s.

Prisoner X got parked in one of the ITU bed spaces and a ventilator did his breathing for him. As I was writing up his notes, the phone by me rang, and I reflexively picked it up, identified my self and then listened.

“Hallo, Can you tell me anything about the condition of Prisoner X at this time?” spake the rather weaselly male voice at the other end of the line.

I was caught on the hop, I was preoccupied with his admission to the unit, I was writing up the notes, I wasn’t thinking straight. I didn’t think who this caller might be.

Even so, I carefully began to reply: “I would say his condition was critical-“….

Then suddenly my good sense kicked in. Who the heck was my interlocutor? Was he this man’s crime boss, his collaborator, a hitman tasked with taking him out, or worst of all a presstitute/journalist sniffing out a gory story?

I paused , then continued: “-but stable”.

The voice quickly said ” ‘Critical but stable’, that’s great doc, thanks a million!” then he hung up.

That evening on the ITU rest room telly, the news programme described Prisoner X’s condition as “critical but stable”. I gaped like the idiot I was at the speed of modern news dissemination.

The next morning, the lady Consultant in charge of ITU arrived in the coffee room . She was a stunning woman of outstanding intelligence, and clearly a beauty in times past, though was ageing badly, and was grossly embittered by a nasty public divorce.

She surveyed the coffee room like a peckish velociraptor might. (That venue was the default refugee camp for all the scared abuse-suffering junior anaesthetists at that particular house of healing you see).

“Which of you lugubrious layabouts spoke to the Press yesterday?” she asked quite plainly but with the threat of torture implicit in her mien.

I realised that this was not an occasion for us all to rise up and declare “I am Spartacus!”, and so I stood up alone in readiness for great punishment.

With eyes and demeanour downcast, Japanese submissive style, I admitted my responsibility, and awaited my doom.

The monster lady’s face quite unexpectedly melted into a rare smile. “Well done Doogie!*”, she said, almost with affection. She continued,

“By the way, what the fuq does ‘Critical But Stable’ actually mean?”.

*Due to my  meek, mild and innocent demeanour at that time, I had been awarded the nickname of ” Doogie Howser”. Look it up, if you are still reading and interested 😉

 

 

Monsters

Monsters are either real or imaginary. The latter are the worse for they stalk and patrol your mind when it is at its weakest, especially in dreams. There is something deeply embedded within the human psyche concerning monsterism. How else can you explain most people’s innate fear and blood-chilled fascination with spiders, cockroaches, biting insects, vicious disease carrying rodents, blood drinking parasites and bats, and flesh rending sharks, reptiles, canines and felines.

Every little boy I have ever met has liked his toy dinosaur model which he swishes around making little roars to give it breath and life. In his imagination he is able to relive a life threatening encounter without having lived and died it the first time. He is in fact unconsciously recreating the cave antics of his caveman ancestors from aeons ago. They used to gather in caves around a fire perhaps, and in the flickering illumination, represent from memory the events they had experienced since their last meeting. At first, everyone would take turns, from the least inhibited to the shyest, but after a while the best of the various actors would be encored for more and more. Theatre and showbusiness were born!

Other arts soon followed: The more talented and observant cavemen would feel the desire to record the dramas enacted before them, by scrawling images of beasts and men on the walls of the caves using charcoal from the fire and whatever soft colourful minerals may have been found lying around. By their inadvertent  choices of non-degradable canvases and  colourants, the works of these poor souls have survived thousands of years, almost as fresh as the day they were made.

Although with technological development most monsters and dangers have either been abolished or contained, the subjective threat level has only been reduced from “real and present danger” to “unlikely but still a possible anxiety”.

In other words, the monsters haven’t gone away, They’ve just gone underground, undercover, dark, sub-fusc, hidden in plain sight, just behind us, breathing down our necks, prowling like a lion looking for a soul to flense first before sucking dry the juices later.

Yes, until this moment in history, monsters had never had it so good!

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Thanks to my upbringing by the telly, cinema, various pictorial comics, the spoken word, the written word, the nightmares, and some deeply unpleasant realities, I have become quite an epicure of monsters, in my imagination at least. Of all of them, the monsters who possess a  human or near human form are by far the mightiest worst! Let me list my top three:

The Cybermen (Dr Who 1966)

Hannibal Lecter (Silence of the Lambs 1991)

Agent Smith, et al (The Matrix 1999)

I could also add all the bloodthirsty dictators and terrorists from history: Stalin, Pol Pot, Hitler, Osama, ISIS etc to the list too. (Feel free to add yours in the comments below).

What all these monsters have in common is a surface resemblance to humanity, which we can all identify with, and even befriend. Underneath however is a lust for dominance, with bloodshed quick to follow.

OK, I saw this clip of the Cybermen when aged 5. Even hiding behind the sofa couldn’t protect me from the spooky music and those cold terror inducing cybermen movements, and the VOICE. This episode of the show shaped my my outlook and personality for life, I’m sure.

 

 

Catholics, go out and change Britain

We face a crisis of humanity. Christians need to act – through politics, the Church and everyday life

Catholics not only have a right to try to transform society, we have a divine mandate. We are constantly told, sometimes by clerics, that we should keep our opinions to ourselves – that we should erect a wall between our faith and our politics. But Jesus did not die quietly or behind closed doors. The Church did not spread his message through private coffee mornings. And the Christian commandment to love our fellow man does not stop at being charitable.

Telling people the truth is an act of love. Failing to do it is a sin of omission. So the question isn’t “Should we try to change our communities?” but “How should we go about it?” The answer is with fearless honesty.

Christianity is tough and uncompromising. The modern notion of the Jesus who loves without asking for anything in return, the Jesus who tolerates, the Jesus of the therapeutic encounter, runs totally contrary to the Jesus of the Gospels. In Matthew, he says: “Do not suppose that I have come to bring peace to the earth. I did not come to bring peace, but a sword … Anyone who loves their father or mother more than me is not worthy of me; anyone who loves their son or daughter more than me is not worthy of me.”

Read the rest of the original article here

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This is a very Catholic Christian article by an author I hugely respect. His points and ideas makes perfect sense to me.

I hereby nail my colours to the mast: Yes, I am a Catholic Christian, and I want to change Britain towards the best, for I love my neighbours and the country that contains and nurtures them, as much as I love my own children and home.

Don’t we all?

I have no idea where this, my declaration of my guileless and imperfect Faith will lead me, but come rack, come rope, come the Grace of God, I know that it will all be for the utmost best.

In the fulness of the fullness of time, of course!

Childhood Imagination

Paddington bloodbath

The above picture hit the internet shortly after the movie “Paddington” (2014) was released. It was clearly the work of someone who had masterly skills with Photoshop.

The bloody and gory parts of the picture are a still from some video game and were obviously inspired by Kubrick’s “The Shining”. Ugh!

Then, right there is innocent little Paddington pasted perfectly in with lighting and shadowing done just so. His hat, duffle-coat, suitcase and friendly smile contrast perfectly with his surroundings

I consider it a piece of very ironic art, though some will call me a complete rotter for publicising it.

Oh Santa, Don’t Darken My Chimney Again!

With only xxx days until Christmas, the seemingly ascendant pagans have already launched their sales-pitches in preparation for their sales-fests. Ugh! I am disgusted by this commercialisation of all that is Holy.

Disgust is in fact the strongest of all human emotions. It is usually triggered by noxious substances in the bloodstream, and by noxious experiences in general. Disgust causes reflex nausea and vomiting, and sometimes fainting. It is a protective emotion originally designed to empty the stomach of any unintentionally ingested toxins. The human body responds commonly to anaesthetic drugs, which are ‘toxic agents’, let’s face it, by N&V.

The following very rude and naughty comedic musical video is from 2012, which marks it as a piece of history, bawdy as it is. I invite you to watch it and enjoy it as if it were part of the old “Carry On” tradition, updated to 2017.

Escape The Cot!

I am sure this is my earliest memory. It must have been 1964. I awoke from sleeping next to my younger brother in our shared cot. It was early dawn and the daylight was peeping through the bedroom curtains. Mum and dad were snoring blissfully in synchrony nearby.

I became possessed by a spirit of explorative restlessness. Standing fully upright I could easily broach the top bar which surmounted the cot’s vertical railings. Without thinking, I swung my leg over the bar, and suddenly I was hanging from it, a foot or two from the carpet below. Bravely, I let go and fell safely into familiar territory. I was a veteran already at carpet-crawling, you see.

Astounded by my new found freedom, I headed towards the light. The bedroom windows came very close to the floor and I was easily afforded a full view out of them.

Then came a great revelation! We lived across the road from a suburban dairy, a place where everyday milk was distributed from. As I watched in fascination, the gates of that place swung open and a fleet of milk-floats sailed forth to perform their morning duties.

Little children are always amazed and inspired by all the things around them that are going about their business. As examples, I offer the baby parked blissfully in front of a churning washing machine or the toddler entranced to stillness by the diggers and bulldozers in the road they are toddling along.

Those milk-floats, them were the jollies for me, that morning! Then I had breakfast.

A few years later, I was walking and witnessed a surprising scene. There was a milk float lying on its side, and firemen were hosing it vigorously. I supposed then that they were trying to wash away all the spilt milk before it created a right stink. In fact, they were probably trying to dilute all the sulphuric acid spilling from the vehicle’s batteries before having to announce a noxious spillage.

Why was it lying on its side? I can only conjecture that it had been involved in a low speed chase, and had lost control during some crazy cornering manoeuvre.

milk-float

Eee, the Unigate 5000, a rocket-ship built for the Milky Way.

Middle Age

I first encountered my middle age in the period Autumn ’95 to Summer ’96. This was when I left the employ of our dear old NHS to explore the spirit of free enterprise. I am talking here of the world of self-employment as a full time medical locum, not that poor Zeebrugge ferry.

With my FRCA qualification under my belt, and our second child on the way, I enlisted the help of the Anaesthetist’s Agency to provide me with continuous locum employment for the foreseeable future. I spent weeks at a time working at Portsmouth and Bournemouth, where I met the yachtie set, and then on to Bath. I would return to my little family in Acton on most weekends and resume family life as best I could. My little daughter got confused by this arrangement. On one weekend trip into town on the tube, she went up to a complete stranger and asked him, with invincible innocence “Are you my Daddy?”! I suffered totally disabling embarrassment, while my more enlightened wife enjoyed equally disabling giggles. Harrumph!

I was covering an awful lot of miles in my little Micra, at all hours. During  those long motorway sessions, I inevitably got to thinking about what would happen if I had an accident, or fell ill. I had no sick-pay as a locum. Although I was earning very well while the sun shined, these fears dampened my ardour somewhat.

Working irregular hours and continuously meeting new people is a sure-fire recipe for picking up some infection that one’s immune system has never met before. Thus, I developed a raging earache (otitis media) and sore throat. I felt unable to work and visited occupational health. As a locum, there was little they could do for me except to advise me to go home and get help from my GP. I had to do this, and after driving 100 miles home in great torment, I next found that my income had abruptly stopped. My worst fears were confirmed: This hand to mouth existence which I was embracing was not a serious proposition for the long term welfare of my loved ones. Cowboys and Pirates, while living the ultimate male dream of freedom, action, and living in the moment, do not great fathers or spouses make. That message I received loud and clear!

Meanwhile though, the Agency had been receiving good reports about me from their customers. Apparently, I was punctual, well mannered, well liked and, bottom of the list, errrh, competent.

My employee score was thus in the ascendant, and so I was offered a plum posting: I was to go out to Germany to provide anaesthetic cover, at Consultant level no less, to the British Army Of the Rhine (BAOR), who were currently disassembling their presence there following the ending of the Cold War. The medical services they had provided needed bridging cover until the German health services could take over.

With our little one at the nursery, my wife accompanied me on the tube to Heathrow. I am a little agoraphobic, and airports overwhelm me the most. I was glad of her company. We enjoyed a Harry Ramsden’s lunch together, and then I went off to board the plane, partly sad but also partly excited. I had never done anything like this before.

The plane ticket had been paid for by the MOD. When I arrived at Düsseldorf, I met two other doctors who were similarly employed, though as juniors. We were whisked by military car to our deployments. I was taken to RAF Wegberg, a greenfield hospital near Mönchengladbach and just adjacent to the large army base of Rheindahlen.

I was shown to the accommodation which while basic and perhaps a bit shabby, was very serviceable. The Officer’s Mess was just across the road and provided food for free, and drink at very little cost, all day and most of the night.

This resource was to be my dietary downfall…..

[To be continued]

RAF Wegberg

RAF Wegberg Hospital. Note the 5/8 octagon layout. Clinical areas were all ground floor, offices above. This picture is from the 1950s. It was all much softer, more weathered and cosier in the 1990s. The Officers Mess is at 10 o’clock by the edge of the picture. My gaff was just to the top of there

An Old Joke

Telephone Tap

I think this story is from Spike Milligan, and this is my retelling of it from memory:

The crusty, ill tempered old Colonel was enjoying his evening scrub in the bath when there was a gentle tap-tap on the door. It was his long-suffering manservant, Chivers.

“I am most sorry to bother you Colonel, especially during your ablutions, but I have a most urgent message for you from the General”, he said, nervously.

“Well slip it under the door, and I will be able to deal with it directly, and make it quick, my man”, said the Colonel.

There was a pause, and then the sound of much heaving and straining. Chivers spoke again, “I am sorry Colonel but I am having difficulty getting the message under the door”.

The short fused Colonel, annoyed at having his bathtime interrupted, replied, “Well blazes man, try a bit harder. You really are a most useless servant!”

There was more heaving and straining, and the bathroom door began to bulge and creak. Chivers spoke again, “I am sorry Sir, but I am encountering the greatest difficulty with this task”.

At this, the Colonel blew his top completely, leapt out of the bath, towelled up, and in a rage tore the bathroom door open.

There, just outside, was Chivers on his hands and knees. “Good grief man! What in Heaven’s name is going on? If you cannot even pass a simple message to me under the bathroom door, then I shall sack you first thing in the morning!”

At this, Chivers stood up, and looking very sheepish, said, “My profoundest apologies, Sir. I could not pass the message to you under the door because,

the message is in my head“.

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There is a common misconception that you can pass on Wisdom by words spoken or written or tapped out on a keyboard.

Lovers of Wisdom have a much tougher problem than Chivers’s to solve.

Their important message to the world, is in their hearts.

Welcome to Brother Burrito’s World

Burrito

Hello friends. For some years I have posted online as ‘Brother Burrito’, a dopey donkey with a wry eye. It all started when I witnessed the comments flying around on various newspaper discussion boards, something akin to a bar-room brawl. I felt drawn to stick my hoof in and found it to be a very stimulating pastime which I could pick up or let drop at any time of the day or night. Like one does, I began to make friends anonymously with strangers of similar hues and views, and a few enemies too. You really can’t please all of the people all of the time.

I learned a lot and my vocabulary, grammar and punctuation improved massively. You see I had been a literary minimalist previously: I barely read or wrote anything apart from some dry articles in medical journals or scrawling a few words and abbreviations galore in patient’s notes.

Anyway, to cut a long and tedious tale to the quick, I have set up my new online home, and will post my past and future musings here instead of to Facebook.

Feel free to comment. You’re all very welcome!

It Ain’t Rocket Science!

I have enjoyed an on and off relationship with brain surgeons since Autumn 1983. A belittling wag might award them the nickname of “excitable tissue doctors”, which while technically accurate connotes all manner of unsavoury images.

First contact was when I was a student regular at the Green College bar, next door to the Radcliffe Infirmary in Oxford. Most evenings two very amiable and urbane middle eastern gents would arrive about 6 o’clock and enjoy a drink or two together. I eventually asked the barman, Cyril, who they were. “They’re neurosurgeons Brian”, he whispered with a certain awe. All I can say is they were not what my 21 year old imagination had expected. They were just too normal! After a while I overcame my shyness, introduced myself and they bought me a drink. They were senior trainees in their art and worked days and nights fixing broken heads, sparing their bosses from much badly timed inconvenience. I left that evening with the distinct impression that I had just met some splendid folk.

Some months later, my studies entered the doldrums: three solid months in the classrooms and lecture theatres studying Pathology. I would advise anyone not to get me started on my attitudes towards Pathology, but I seem to have started anyway, so I’ll finish. If the practice of medicine is pictured as a football tournament versus the Heavenly Host, then I, an Intensivist, am one of the goalies (for our side). It is my task to deflect souls from the goal-mouth, or catch them, and kick them back into play. It’s all good sport! Pathologists on the other hand just barely seem to keep the score, and maintain museums of permanently punctured footballs for nostalgia’s sake or something. They also seem to be in cahoots with the more serious colleagues of Mr Plod, which always scares me.

It wasn’t all dull. For some reason most of the Pathology faculty were pale, wry, sardonic, good-humoured and witty, ie Scots! They all possessed that look that belies a love of drink and good craic. My group’s tutor was one of the younger ones. He fessed up that earlier in his career he had wanted to be a neurosurgeon. We all asked why he didn’t pursue that path. “In all honesty”, he replied, “when I realised what SUCCESSFUL treatment in that specialty actually meant, the glamour wore off rather rapidly”. He was referring of course to the generally poor prognosis that brain-injured patients have.

The following Summer, I was attached to Neurosurgery proper, for a month. Day one I waited in theatre and observed a patient being anaesthetised and their head being shaved then clamped in some device that held it perfectly still. The scalp was lathered with antiseptic and the drapes applied. The lesser surgeons started by incising the scalp, stopping the bleeding, retracting the scalp flap, drilling holes in the bare bone beneath, and then cutting the bone between the holes with a wire saw, powered by their own hands. It was all fascinating, yet the best was still to come.

The doors flew open. A figure entered with a face like thunder, and his arms stretched out in front of him, like some zombie, or Hector from Hector’s House. A Geisha-like scrub nurse meekly held up an unfurled theatre gown. He walked into it and it was tied up. A surgical mask was tied over his nose and mouth, and he donned his gloves aseptically. Like a well rehearsed Shakespearean actor he took centre stage and performed. All theatre noise hushed. The operating microscope he drew down, peered through it, asked for the right instruments and proceeded to operate flawlessly to remove the tumour. He never lost his cool nor his flow nor temper during the several hours he worked. The tumour excised, he retired and his little helpers finished the routine closure and the rest.

Was I impressed? Heavens YEAH! I won’t tell you his name, though he was often referred to unofficially as Mr “Grizzly”.

[Part two will come later]