Life In The Section-House

I wrote this little true-life story many years ago. There is no patient-identifiable information in it. It is worth a read, I think.

Just recently, my little hospital became very busy, out of hours. I had spent the early evening anaesthetizing a patient with a fractured wrist. Halfway through, I was alerted by the midwives that there was a lady who needed a top-urgent caesarean section. I summoned the second call team and they commenced the caesarean just as my case was ending.

As I settled my patient into the recovery room, the doors of the other theatre were flung open and I was urgently called inside. Baby had been born, but it had been a technically difficult and prolonged operation. Poor baby was very floppy and pale, and her pulse rate was very slow. These are signs of severe oxygen starvation. The junior paediatrician was out of his depth, but it had been more than ten years since I had been on a neonatal resuscitation course, let alone done it hands on. I could hear the mother and father sobbing and fretting across the theatre. Baby was seconds from death. Something had to be done!

Resuscitation is a bit like re-lighting a dying fire: Get oxygen to the cells before the spark of life has completely gone out, and life will flare back. A breathing tube was placed in the windpipe and the stiff little lungs inflated. The heart was still slowing down: the blood was not bringing the oxygen to the tissues. We’ve all seen external chest compressions on TV medical soaps, but on a patient the size of a small oven-ready chicken it’s a more subtle affair. With two fingers pressing on the little breastbone twice per second, I massaged the blood around her body. Minutes ticked by, but baby remained pale and lifeless. I prayed under my breath, “Holy Mary, Mother of God…”

Then, suddenly, baby took a breath: her brainstem was alive! I listened to the heart: it was less slow than before. The skin started to pink up: the circulation was coming back. At this point the consultant paediatrician arrived and took over all care. Baby was moved to the special care unit. I went over to reassure the parents, but mum floored me with her first question: “Is she brain damaged?”

“It’s too early to say….but she is alive….She so nearly died….” I answered, unconvincingly. The parents remained so inconsolable. As upset as they were, nothing I could have said would have helped them.

The caesarean continued. I went down to see baby. A miracle had happened in the meantime. Baby was breathing easily by herself, without the tube. She was moving all her limbs and looking around. She was gnawing vigorously on her knuckles, desperate for her first breakfast!

It is possible to be both humbled and proud at the same time. A Talmudic quote came to mind:

“Whoever saves one life saves the world entire.”

To endure the painful difficulties of providing good healthcare, mostly against the odds, we all need to experience, from time to time, our efforts making a real difference. There’s nowt as consoling as success.

(Baby continued to do well, and went home.)

Benign Crustiness

There are certain aspects of Britain’s crusty old laws and traditions that warm my heart.

The first is that if there is an air traffic conflict between an aircraft carrying a human casualty and one carrying one of the Royal Family, the poor sick person gets priority.

The second is that if someone were to be summoned simultaneously to both Her Majesty’s Coroner’s court and to the House of Lords, the Coroner wins.

These little things demonstrate an innate respect for the human person that is lacking in the wider legal and social consciousness.

Long may such rules apply. God bless you Ma’am.

Paperwork

I truly, truly and really hate all paperwork! Let me explain:

I was conceived and born and raised to adulthood as the fifth of six siblings, all without paperwork.

I got into medical school on the strength of my oral testimony as an interviewee. I can only guess that I came across as weirdly worth a bet. Whatever the strangeness of my answers to their interrogation, I forget now, but they earned me a full Scholarship to Oxford.

OK, I had to unavoidably sit some exams thereafter but where I am today was mainly achieved by tears, sweat and blood, most of which was of my own instigation as a common fool. Little paperwork was involved, apart from the wipes needed to mop up all those bodily fluids.

I look at the junior docs, nurses, and other HCPs coming up to replace me and I despair for them. It seems like the ruling regime wants a compleat record of their every breath, bowel action, thought, and even despairing wish, before they will be admitted to the next highest level of centrally “governanced” mental torture. Suck all the joy out of learning one’s trade whydontcha?

The only way I can see the future of healthcare training, and humanity overall, is if we ditch “paper truths” and rely more on the more simple and reliable mechanisms that we are all naturally endowed with: Compassion, empathy, human intelligence, and the ability to smell a rat.

Once upon a time, the various professions necessary for the survival of the human race were ruled and regulated by “guilds”. These were professional social structures governed by masters, of apprentices, the latter eventually becoming the next former.

In all truth, I see no material reason why we as a society cannot return to such a way of doing things. At the very least there would be way less wasted paper, and thus fewer slaughtered trees, and fewer dispirited youngsters.

Silent Cockpit

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

It is called “SILENT COCKPIT!”.

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

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

Sometimes however, reality violently subverts the dolce vita.

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

Risk can be analysed, calculated and planned for, but hazard is in your face, a very present danger. It needs one’s immediate attention, wakefulness and concentration to deal with it.

Smooth running routine has the unfortunate effect of sedating people and engendering complacence. A clear warning signal must be agreed upon that wakes everyone up without scaring the bejeepers out of any bystanders, and which contains within it its full meaning and purpose:

SILENT – as in all chatter, backchat and distraction must cease immediately.

COCKPIT – as in the centre which is currently controlling all life and death must be facilitated to the maximum.

There have been many versions of choice cries designed to summon collective effective action such as “Wolf!”, “Hue!”, “Attention all hands!”, and “Now hear this!”.

The phrase for today, I think, is “SILENT COCKPIT!”.

Everyone who ever has to utter or hear that phrase, can be drilled in it until their response is mindlessly reflexive yet responsive.

What is certain is that nobody will ever effectively say “SILENT COCKPIT!” on Facebook: It would be a total waste of time 😉

Pontifex Minimus

I have decided that I no longer want to make a lot of money, fame or, errh, trouble.

Rather, I would like to make a lot more sense (to both others and myself), and a lot more friends.

This making of sensible friends, and kindred souls is harder than it sounds.

Huge gulfs of background and experience, attitudes and thought processes, prejudices and selfishness must be bridged for this to succeed.

Yep, I have found myself a new vocation: as a bridge-builder on a small scale.

Or as it might be put in Latin, a “pontifex minimus”

Good News

“That was the finest breakfast I have ever eaten” I honestly remarked to my wife as I took the empty plate to the dishwasher.

I saw her wry smile and her eyes lift heavenward, and I read her thoughts: “More bull and flattery from him-indoors, as usual”. She knows me so well, you see.

But, as usual, it got me thinking. It would be wrong, a sin even, I thought, if whenever one witnessed Goodness, Beauty, Love or Truth, one did not sing Praise!

We live in a world which fairly equally mixes all of the above with their opposites: badness, ugliness, indifference and lies.

Yesterday’s Gospel told the parable of the wheat and the tares.

Much of life involves no choice, and therefore no moral dilemmas or culpability. It is in the little things that we can choose well or ill and make a difference, as St David tells us.

If you see good stuff coming at you out of the blue, make a fuss about it, rejoice loudly, and let all the citizens of the City of God hear it and resound with it.

Good News must be shared joyfully. Bad news only makes good fishwrap.

31 Years!

I have been a doctor for 31 years and two days. My house jobs were in ENT, general surgery and medicine. I spent six months as an A&E doctor where I discovered that anaesthetists were the true masters of serious illness and trauma. Whenever they attended the frenetic dramas of the resus’ room, a calm orderliness descended and everything began to become very well, or at least much better.

I thought then, with ungreedy ambition: I want some of that!

And so I am here, all that time later. Although I am a sort of distractable dreamy kind of guy, experience has shown me that when needs must, I have the right thoughts and make the right moves, and the salvageable patients get saved.

I freely admit to making some clinical decisions over the years, which with 20/20 retrospection appear unwise. These were always made when I was severely fatigued or when I was urgently seeking rest. Neither doctors, nurses nor any earthly agents of goodwill are totally tireless angels.

At the end of the day, one can only do one’s best.

Let me finish by remarking how much I dislike futile medical care. I have witnessed too much “useless striving futilely to keep alive”. It has made me a hugely big fan of Palliative Care, an under-resourced but enormously rewarding, though “Cinderella” speciality within the NHS.

The NHS must begin to stand for the National HOSPICE Service

The days of free-for-all total healthcare are coming to a close. The money just ain’t there. What money there is must go to maternity and paediatics, for there lies our future, as a race.

To all the rest of us, the dying, I prescribe Brompton Cocktails, on the house, all round, with Cheers!

Brompton cocktail — sometimes called a Brompton mixture, Brompton’s cocktail — is an elixir meant for use as a pain suppressant, and dosed for prophylaxis. Made from morphine or diacetylmorphine (heroin), cocaine, highly-pure ethyl alcohol (some recipes specify gin), and sometimes with chlorpromazin…
EN.WIKIPEDIA.ORG

A Near Death Experience

The other day, for no discernible reason I found myself tapping out this little true-life anecdote. I enjoy writing stuff like a fitness addict likes to exercise. It is pleasantly challenging, and at the end of it you are left with something you can share, though less enjoyable than my wife’s loaves and cakes, the making of which is her hobby. Copy begins:

“Let me tell you about the day I died.

I recently related how I once pretended to be dead, so as to spoof some colleagues. Let me tell you now how I came so close to death that ever since, I have felt myself to be continuously on the threshold of that state.

About 25 years ago, on a Summer Saturday, I met up with some old school friends from 12 years before. We picnicked the afternoon away in a sunny meadow in north-east Oxford. The food was plentiful, but the wine was more so. We were near the river Cherwell, and by the evening we all decided that it would be great fun to take a punt on that river.

In Oxford, a punt is a shallow bottomed boat propelled by pushing a long pole against the river bed. It does not mean “a gambling bet”. Punting has inspired some truly awful jokes, such as: Question: “What is the connection between punting and Watneys beer?” Answer: “They’re both f**king close to water!”. etc.

So, the whole party, with vine-fuelled alacrity, trumped off to the nearest punt-merchant’s premises, which was the Cherwell boathouse in north Oxford. We hired a couple of punts and sailed north against the stream to the Victoria Arms in Marston, a famous riverside pub, (featured in the Inspector Morse TV programmes, if you are interested).

“Much Guinness zooms down past lips now” (MGZDPLN) – that is a mnemonic for the branches of the maxillary nerve btw- accurately describes what happened there. We suddenly realised we had to get home while the sun was still in the sky. Dangerously stocious, we all boarded our punts and set sail to the south to reclaim our deposits.

Although I couldn’t swim, I was tremendously proud of my punting technique. Instead of lifting the pole clear out of the water with each stroke, I merely flipped it over by 180 degrees at the middle point and plunged the other end into the soggy riverbed advancing towards me. This technique had worked for me for years before, but not this night.

The pole hit a very adhesive bit of sediment, got stuck, and I held on too long……

I fell in, with a quiet plop, because I was too chilled to scream for help.

My drunkenly preoccupied friends coasted on downriver, regardless of the fact that I was suddenly in mortal peril. It was by this time after sunset, and the afterglow in the sky was rapidly diminishing.

I sunk far into the chilling murky deepness of the Cherwell. During my rapid traverse downwards I even thought about it’s infestation with Weil’s disease, which was something I had read about at medical school. I’ve always had a problem with paying attention and ordering my priorities, especially in the present moment.

Everything was occurring in slow motion. The viscosity of the water helped make this reality. My feet eventually touched the squidgy river bottom, about seven feet down. Fortunately my lungs were already filled to their vital capacity, but I knew from experience that even so I wasn’t capable of floating passively to the surface, my being of a rather dense construction.

I crouched then leapt upwards with all my strength towards the dim light above. I broke the surface and my uplifted hands touched some drooping twigs from the overhanging trees, but failed to grasp them. Back down I sank, a little disappointed I must admit.

I tried again but didn’t even touch the trees this time. As I submerged for the third time, I remembered how in folklore drowning persons only come up three times. Panic began to introduce herself to me. With a grim resigned inner smile I remarked to myself “What an utterly facile and silly way for me to die….”.

By now, after all my strenuous efforts and no effective ventilation of my lungs, my carbon dioxide levels were high, and my blood was probably getting blue. As a result my adrenal glands did their thing and bolused my bloodstream with a pre-terminal dose of adrenaline. My circulation ramped up and my feeble musculature prepared for its final desperate offices. I pushed upwards again, despairingly this time. The light above me was now completely gone.

Lo! Behold! My fingers touched upon a solid hard smooth-ish thing that was passing along the water’s surface above me. Quite by autopilot my hands explored this thing and found an edge that could be gripped. I pulled hard and brought my head above the surface and my exhalation was like a bull’s roar. If there had been any cliff faces nearby, there would have been some impressive echoes.

Look you, my friends’ flotilla of pleasure craft, now a way off downstream, were not the last ones afloat that evening. My salvation came in the form of another punt that had been just behind mine. It was full of young Japanese tourists, male and female. My sudden noisy appearance from the realm of Neptune, in that setting, obviously disquieted them greatly. It must have resembled a scene from a horror movie as my muddy and be-weeded head noisily popped up in the quiet gloom. My ears were assaulted by their screams and curses shouted in an unknown tongue. Then I thought I was seeing stars and supernovae, but in fact they were just camera flashes.

As my rapid gasping restored my blood gases and my head cleared I began to see everything as it really was. This worthless bogger’s life had just been saved from certain death by complete strangers, working unknowingly.

My new incomprehensible friends also began to understand the situation. I was too heavy and the punt was too unstable for me to be brought aboard, so they carried me like a grateful limpet with them downstream to the boathouse’s wharf a short distance away. My friends were already there, wondering cluelessly where I had got to. As I gripped the wharfside boards and said farewell to my saviours, my chums noticed me and helped pull me up and out of the water. I immediately began to drip dry and shiver in my sodden muddiness. I really wished I could do that spin-dry thing that dogs do. There was insufficient privacy for me to strip off my soaked clothing, but someone found a towel from somewhere, which helped a lot.

Still chilled to the marrow, I audited my situation. Though earlier intoxicated by alcohol, I now felt as sober as a judge on an adrenaline high. My pupils must have been dilated as I found the night quite bright. I also had an enormous appetite for food, which my friends thankfully shared. We retired to an Italian restaurant nearby and feasted mightily. As my stomach filled, my consciousness began to resume normal proportions. The last thing I remember perceiving with heightened awareness was the casting-central machismo Italian waiter making a great show of his mastership with his enormous pepper grinder 😉

I fell asleep as I was driven back to London but woke enough to get back into my Acton flat and fall into bed. Busy day the next it was, as Yoda might say. In those days you see I was an “Acton Man” – geddit?

Verdict: A grand day out!”

Copy ends.

Graceful Thinking

I remember being told once that if all the people in China jumped up in the air together and stamped very hard as they landed, it would cause an earthquake and tsunami that would obliterate the human race.

I intuited that this was probably nonsense, but it got me thinking.

I thought: If every soul on this planet, each day, did just one good un-self-conscious thankless but kindly act each day, then the universe’s ultimate and unavoidable entropic heat death would be not averted but perhaps be sweetened justified and given joyful meaning. I still believe this: One good deed inspires another, like some uber-beneficent virus.

I read earlier a post about JRR Tolkien’s views on history as being a one way journey to worseness, and how progress is a false god we are all worshipping at the moment. I tend to agree with him.

But I still have Hope. Life clearly evolves and improves despite the thermodynamic inevitability. There is a hidden force at work which is continually and miraculously bringing brass from muck. I cannot explain it, I am only sure it is there.

I am filled with Hope which I cannot explain in mere words.

Although despair and hopelessness roam the streets of our Godless age, I tell you what: If they knock at my door tonight, they will get very blooded noses in return, and no apologies either!

Parenthood

Call it a mid-life or late-life crisis, but I often wish I was a baby again, especially one tossed lovingly in the air for giggling’s sake.

To be so trusting and carefree and gleeful in the presence of my beloved. Ah what joy!

Babies are humankind at its purest and finest. Their helplessness inspires the mightiest of human efforts:

Parenthood.