Half-Pint Alf*

I alluded to Alf, one of my all time heroes, previously here.

Alf Gunning was born in 1918, so when I first observed him in action, he was approaching retirement from the NHS. Although he looked his age, he didn’t act it. He was a short wiry bristling fellow who was omnipresent at the John Radcliffe and Churchill hospitals in Oxford. He was a bit of demon at playing squash, apparently. You could spot him a mile off as he always wore a white coat with short sleeves, as if ever-ready to dive into some surgical maelstrom.

Here is an excerpt from his obituary (2011). Please read it! :

He was a remarkably unassuming surgeon who nevertheless inspired dedication in those who worked with him. On one occasion he entered the ward late at night and was mistaken by the nurse for the plumber, and was asked to repair a leaking tap. He fixed the tap and then asked the nurse if he could now do his ward round!

He was a member of Pete’s Club, a travelling surgical club where the only rule was that ‘no case that is presented shall throw credit on the presenter’. Only errors of judgement were discussed, and members consequently learnt a tremendous amount, much more than at other national surgical meetings.

I can confirm as an eye-witness that Alf was gifted with the precious gift of un-self-consciousness. There was no pride or guile in him. He possessed pure unalloyed surgical genius, and he wielded it very well. He saved and improved many lives through his works. I wish I could show a picture of him, but the internet has not been helpful this time.

*Not only was he short in stature, but the only time I saw him, in his blazer and tie, purchasing a drink at the Green College bar, it was a half-pint of shandy.

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Epidoodles*

This is not boasting but merely a statement of fact: I have sited more epidural catheters than some of you have had hot dinners. Most of these have been for ladies despairing of their life amidst the onslaught of pain during childbirth. The pain relief thus delivered is almost miraculously effective. Within minutes, a screaming suicidal mother-to-be is transformed into a snoozing kitten, and her labour continues safely onwards. In the event that delivery needs assistance by forceps or caesarean, the epidural just gets topped up and away we go.

I had a great teacher: Jane, an immaculate English rose with perfect diction, was one of my first bosses. Her voice rather resembled Lady Penelope’s from Thunderbirds. I like to think I was her Parker (Yeshh, milady!). She was a graduate cum laude of the famous Oxford Pain Clinic and was a mistress of her art. She taught me the then rarely used paramedian approach to the epidural space, which I still use to this day. I have since passed on this invaluable skill to innumerable pupils over the years.

Epidurals are actually potentially very dangerous. A whoppingly huge needle gets advanced through the skin, subcutaneous fat and ligaments of the spine until its tip lies within a millimetre of the dural sac containing the spinal cord or the nerve roots arising from it. Then either drugs are injected directly, or a fine plastic catheter is fed through the needle so that several centimetres of it lie in the epidural space. The needle gets removed over the catheter and a sterile filter hub gets affixed to the free end of the tubing thus sealing it off from germs. Via this route, all manner of medications can be delivered directly to the near vicinity of the central nervous system: local anaesthetics, opiates, clonidine, depot-steroids, and others have all been tried and found useful.

One of my finest moments happened when I was confronted by a woman who was riddled with advanced and widely metastasised breast cancer. She was in unbearable pain. Her heavy oral morphine dosage was insufficiently effective and was giving her unbearable side effects, nausea and constipation mainly. I provided her with an epidural catheter and injected a very modest 5mg of diamorphine through it. Within minutes, her pains were negligible, and she heartily sighed with relief. She did not have long to live, but her oral meds were stopped and the side effects from them melted away. Her pain relief was provided purely via the epidural instead. She died unharassed by physical agony.

Another of my talents, not mentioned on my CV, is songwriting. I composed this little ditty for one of the hospital Christmas shows I participated in:

Labour,
Everybody is in labour!
With a little epidural
-You could have a baby everyday!
Labour is now consumer-friendly
Thanks to your gasman, and Oh-Dee-Ay**.

(this should be sung to the tune of “Neighbours”)

 

*My 4 year old daughter asked me why I had to leave the dinner table in such a hurry. I explained that I had to do an epidural. The next day at school, she was telling everyone that her daddy did “epidoodles”, apparently.

** An ODA is every anaesthetist’s assistant/saviour/mentor/bloody-great-mate. They are the great unsung heroes of the NHS, to whom I am perpetually indebted: Operating Department Assistant. (Apparently they are now called “Practitioners”).

Getting Sacked-Part Two

(Part one is here)

I had no luck with the locum agency, so I rang my old boss Mary, whom I had worked for two years before and had got on very well with. She was also Australian but much truer to stereotype! She listened to my sob-story and even over the phone, I could hear her eyes lifting heavenward as she admitted knowing my antagonist socially and only too well. “Poor, foolish Danny” she lamented. As it happened, she had a vacancy for a registrar at her hospital, and I was welcome to start Monday Morning. My low mood immediately started to lift. For some reason, all of the most important and helpful people in my life have been called Mary.

The thing about revisiting one’s old haunts is that everything, and most everyone has changed. The Consultants were mostly the same, with a few new faces to get used to, but the juniors were all fresh. There was the outrageously Welsh Sion, who was married to a ballerina. There was Murph, the sensible but adventurous second generation Irishman (like myself), and there was the lovely Leela who was a perfect lady. There were many other splendid young doctors too, but I forget their details. I stayed there for two to three months until a substantive replacement took over from me. Then I sampled the locum job market again.

Lo and behold, I was offered work back at the big city teaching hospital where I had spent a year before. I was taken on as an acting senior registrar this time, which was a hat-tip to my greater experience. This was where I met my second nemesis: Annie.

Annie was a very devout but joyless puritan, and I guess she won few souls for Christ by her example. She looked older than her early middle age, what with her school-ma’amish twin-set and pearls and her enormous optical glazing designed to camouflage her narrow-set eyes which blinked uncannily regularly and very fast. The lenses were steel rimmed and often reflected the glare from the ceiling lights disconcertingly.

I had form with Annie. I had accompanied her during an operating list with Mike, a senior registrar. As the morning wore on, I became increasingly tired of her continuous mithering and negativity about everything in the observable universe in general, and the clinical situation in particular. I eventually snapped, and said to her “Hey Dr Annie, I don’t know about you, but I’ve got a really good feeling about this anaesthetic!! I delivered this with my most winning and sunny forced smile. I was being facetiously facile, of course, but it worked.

Mike, who was gowned up for some sterile procedure, creased up and had to leave the room to guffaw safely elsewhere. Annie’s face meanwhile blinked a lot more than usual, and then gave the “DOES NOT COMPUTE” signal. The rest of the list proceeded as it should, with simplicity and common sense. Annie had been safely discombobulated.

On another occasion, I accompanied Annie as she visited her high risk obstetric cases who were scheduled for caesarean section the next morning. These women were all afflicted with serious cardiovascular, respiratory or endocrine conditions but were also carrying their babies to term, and needed senior medical help to survive delivery. Alas, they were all mostly of a hardy, chopsy, working-class background, and not the sort that Annie invited round to supper. Losing her patience with their cheeky obstreperousness, Annie said to one of these ladies “Listen dearie, one of us has a 50% chance of dying tomorrow, and it isn’t me!”* As bedside manners go, that struck me as a bit harsh. The patient was left speechless, and we passed on to the next.

Annie was terribly OCD. She would check through all the anaesthetic charts filled out by the juniors from the day before. Any deficiencies at all would surely get addressed. Around 2pm the day after your on-call, your bleep would always go off. We jokingly called it the “Number of the Beast”. It was Annie inviting you to your very own personal inquisition in her office. There she rejoiced in telling you that you had misspelt some drug, or missed out some or other datum. No amount of remorse seemed to satisfy her. All in all, it was a very dispiriting exercise.

I was summoned to her court after a few weeks of my locum re-visitation. As I entered the room she was busy making notes about something and she kept me waiting nervously. Then she looked up and flourished a crumpled and dog-eared piece of paper at me. “Do you recognise this?” she said. I saw the messy writing, barely improved since kindergarten, and the ink blots, and the over-minimalist sparseness of the recordings.

It was a fair cop. “That would be one of my my charts from yesterday”, I confessed, with my head held low, guessing something bad was about to happen.

“I’m sorry Dr Burrito, but this is totally unacceptable!” she began. “You are a senior registrar now, and I deem you unfit to continue working at this great institution while you practise chart-keeping at such a low standard.” I gulped.

Her eyes softened to a simulacrum of compassion. “I’m sorry BB, but I am going to have to let you go!”*

(As I only held a locum position, she was quite within her rights to terminate my employment at any moment. I just hadn’t expected it could happen so suddenly.)

Shocked and awed, I asked her if she was perhaps pulling my leg, but she confirmed that I had to get changed, collect my belongings, and leave the premises immediately, or she would have to call security. As it happened, I left so fast, you couldn’t see me for dust, but I felt quite traumatised by this unexpected change in my fortunes. I returned to my empty and soul-less flat to contemplate my options. None of my friends were answering their phones. I felt very alone, again.

*********************************************************

A year or two later, I was awakened from my nightmares by the unmistakable dulcent whining* of dear Annie coming from my alarm-clock-radio. She was being interviewed by John Humphreys on Radio 4’s Today program. She and her team had performed serial MRI scans on pregnant women and had conclusively shown that pregnancy causes women’s brains to shrink somewhat during pregnancy. She was evidently very proud of her scientific achievement, but I remember sleepily thinking to myself that she had not won any friends amongst the feminazi sisterhood.

*The closest thing I have found on YouTube to Annie’s speaking voice is Orville the Duck singing, ahem, “Annie’s Song”:

Getting Sacked-Part One

I have been sacked from employment on two occasions, and currently I await the third. You all know that I am about to spill the beans about these sackings. If such details don’t interest you, then please look away now.

The first time was at the cancer hospital (where I met Mrs Burrito). My boss was an antipodean of small stature and large ego. Talk about opposites! I was of larger stature but smaller ego, it having been beaten out of me by the serial humiliation of medical training at that time, and I was born on the other side of the world from this guy.

We didn’t get on too well, from the start. I had previously met and befriended many medics from the “colonies” during my career. I appreciated their good-humoured vigour, un-stuffiness,  and down-to-earthiness, and they appreciated my similar style. This boss was totally different. For one thing he was a bit pretentious. He had ditched his Ozzie twang for a more received pronunciation. He lived in a huge house with a big garden in a wealthy western suburb. Every summer, he would host an opera there, at which he would sing the lead male part. He also commuted to work on an enormous motorbike, which was clearly an extension of his, errrh, self. In comparison, I was a beggar living from hand to mouth since taking on a crippling mortgage to purchase my one bedroom flat in a rather rough area. My neighbourhood included such delights as shameless drug dealers, knife attacks, all night rap music and singing drunks. I commuted to work by bus and Shanks’s pony, and lived on beans and rice.

The hospital happened to be a bit world-famous, and was chosen by a big drug company to be the UK launch-site of their new intravenous non-steroidal anti-inflammatory drug (NSAID) called Toradol. On paper, it sounded good, and a possibly useful addition to the anaesthetist’s armamentarium. Although it had passed all clinical trials, it had yet to be rolled out into the wild. Our institution’s good name was sought to help promote it. Perhaps a lot of schmoozing took place behind the scenes, but I couldn’t possibly comment.

Launch day arrived. The great and the good all assembled in the auditorium, and also I was coerced to attend, despite being exhausted by a prior 24 hour on-call shift. Drifting in and out of sleep, I endured an hour of ultra-glossy Powerpoint presentations without snoring out loud. The audience were asked if they had any questions or points to make. A shy silence descended, which woke me up. Like the dormouse at the Mad-Hatter’s Tea Party, I raised my arm, and was invited to speak.

“This drug sounds wonderful”, I said, “but has your marketing department got the product name quite right?” I was asked to expand upon this.

“You see, I have just noticed that TORADOL spelt backwards is LODAROT!”

Apparently nobody saw this coming. Amidst much senior embarrassment, and sniggering amongst the ranks, I was advised to go home, and ushered out. The grown-ups ran damage control and the meeting continued to its natural end. The drug got launched.

In the ensuing week, several Consultants thanked me for brightening a rather dull afternoon, but my boss marked me down as a troublemaker.

This job was my last one of a three year registrar rotation but I had been basically promised an indefinite extension of this employment until I got a senior-registrar’s post. Alas, this wasn’t to happen. In the final fortnight, my boss and I had a terminal falling out.

A young woman was admitted to intensive care with severe pneumonia, and no functioning immune system, due to chemotherapy. Her lungs became solid with fluids and leukaemia cells. It was very difficult to ventilate them as a result. Even 100% oxygen was insufficient to keep her blood red, and we couldn’t control her carbon dioxide levels either. (In retrospect, she was clearly dying: her condition was irrecoverable. However, this hospital’s ethos was “never say die”). My boss wheeled out his new toy: the high frequency jet ventilator. This was cutting edge technology that promised to provide minute puffs of oxygen at a high rate, without risking barotrauma to the stiff lungs, and also promised CO2 clearance as well. We hooked her up to this noisy device but there was no improvement. As it was Friday evening, my boss went off home, and left me a phone number of a friend of his in the Midlands who was an expert on this machine. The patient continued to deteriorate. I tried the number but got no response. I took the girl off the HFJV and reverted to the normal ventilator with which I was more familiar. Sadly, the young woman still died.

Come Monday morning, I had to explain my actions. My boss saw only that I had completely disobeyed his orders and had gone out on my own. I was thus no longer welcome there. I served the few days left of my contract, and then was sacked and put out in the cold.

On the Saturday morning after my sacking, the phone rang early. It was my ex-boss. He wanted to talk. I said OK. Somehow, he knew my number and address. He came in through my front door in motorcycle helmet and leathers. He noticed that I was drinking a can of beer at 9 am and tutted at me. He showed no insight into my situation as somebody just thrown into unemployment and possibly unemployability. I politely listened to his speech, and shook hands with him as I let him out the door.

Then I rang the locum agency and urgently sought some honest lucre, the better to face my future with.

czvtioyd

My boss in a generous mood

 

Modesty And Humility

I just came across this on YouTube, and it moved me to tears:

I sense in his words the genuine voice of Goodness, Beauty, Truth and Love, discovered by him the hard way, through very bitter experiences. By his speaking out like this, he truly gives Glory to God.

His modesty, humility and honesty are totally compelling. I suggest you all might watch his longer TED talk here:

 

Declaration of interest: I am a Roman Catholic, who unexpectedly finds Divine Goodness at work in all manner of places.

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

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…..

####################################

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.