MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'floor'. Sat, 03 Sep 2011 02:29:55 +0100 http://www.medworm.com/index.php?rid=4960120&cid=t_119628_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F06%2F22%2Fcan-you-take-someone-to-the-er-for-mental-health-help%2F When I came home from work, she was sitting on the back porch steps, crying. Another friend was sitting next to her, arms draped around her shaking shoulders, trying to understand the words in between her hiccuped sobs. “Is everything okay?” I asked, even though I knew this wasn’t just a normal bout of tears. Julie (not her real name) had been crying the entire day. When I left for work she had been sobbing in the bathroom, and (I learned later) had turned on the shower to muffle the sound of her emotion from the rest of the house so no one would come and check on her. No one knew how long she had stayed like that, melted to the bathroom floor, clutching a towel to her chest, the shower running hot and humid whenever she felt she was getting too loud. It’s possible ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4960120 Wed, 22 Jun 2011 18:45:24 +0100 4960120 http://www.medworm.com/index.php?rid=4794819&cid=t_119628_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2011%2F05%2F06%2Fnursing-times-2011-vol-107-no-17%2F Fade Fave: Pelvic floor health: information for teenagers Fade Skinny: Young women were involved in developing a leaflet about pelvic floor awareness with the aim of maintaining and improving pelvic floor health. Contact the Library for a copy of this article Filed under: Ooops Missed Category! Tagged: Focus Group, Health Promotion, Leaflet, Pelvic Floor Muscle Exercise, Teenagers (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=4794819 Fri, 06 May 2011 11:08:18 +0100 4794819 http://www.medworm.com/index.php?rid=4670119&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2011%2F04%2Fshaking-what-youve-got.html Another interlude. Typing on my iPhone, so may be shorter than usual. It's awkward, and the events herein upset me.On how things go wrong, and on not knowing.The patient, hypothetical as always, might have been middle aged and in renal failure requiring regular dialysis. Imagine they present with a nosebleed. These are the patients who carry a burden of hindsight with them. It is neatly packaged, and in my experience you won't see it unless you're careful.Patients with open fractures, overdoses, an overcrowded Paeds Department: all of these things might get in your way, might cloud your vision.Suppose the bleeding starts again. It's obviously vigourous; despite packing, blood continues to flow freely, from the other nostril and from the mouth, obviously coursing down the back of the nasoph... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=4670119 Fri, 01 Apr 2011 23:07:00 +0100 4670119 http://www.medworm.com/index.php?rid=4653342&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2011%2F03%2Finterlude-referral-politics-2.html So: the last of the epic tales of my on call.I knew I'd be late on the floor; 2 down and busy, no way was I getting off on time. Half two in the morning is close to my limit. If there are sick patients, well, strap on when it seems apt, but if its just busy...As I was preparing to escape, I was introduced o one of my absolute favourite ED dilemmas. The 'problem' patient that no-one will admit, or discharge. Typically, this will be someone well known to one service, or more than one, with a chronic problem. They inevitably attend out of hours, with a flare of their problem, usually requiring strong painkillers.In this case, the problem was abdominal pain. Surgical review diagnosed "not a surgical problem' with a plan of "refer medics'. But of course, the surgeon couldn't possible make that ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=4653342 Tue, 29 Mar 2011 13:08:00 +0100 4653342 http://www.medworm.com/index.php?rid=4642605&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2011%2F03%2Finterlude-referral-politics.html Ah, the joy of the referral.Times have changed. The all powerful target means less time for us, in the ED to reach a diagnosis; often the decision to refer for admission is based on a lack of a diagnosis, coupled with the fact that the hospital says I can't stop and think.And so, the soft referral. I like to think that most of my referrals are kosher, and if I'm not sure, I'm honest about it. But sometimes, I just don't know what's wrong with a patient, but I'm pretty certain they need longer obs than I can offer in the ED, and maybe more tests. (More tests! The answer to everything!)I had just a conundrum recently, and was given a hard time by the MedReg. Not necessarily inappropriately; I really couldn't figure out what was afoot, but I tried to be honest about that, and why I though the... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=4642605 Mon, 28 Mar 2011 09:44:00 +0100 4642605 http://www.medworm.com/index.php?rid=4592403&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2011%2F03%2Finterlude-part-second.html Another bad day. Bad for me, worse for others.I had an unusual case yesterday, wherein a 21 year old lad presented with severe lower limb muscle spasm, and turned out to have bilateral fractured femoral necks; without significant trauma.Yes, I'm stumped, too.Today...the first was a young man, in his 60s, previously well, in cardiac arrest. He had had a colonoscopy the previous day, and returned home without complication; after a few hours at home, he developed severe lower abdominal pain, cramping and colicky, although the notes document that this passed when he opened his bowels and passed flatus.The notes document that he was symptom free when seen in the ED. He examined normally, and was discharged. Then she couldn't wake him this morning.By the time he got to us, the Ambos had been wor... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=4592403 Tue, 15 Mar 2011 21:42:00 +0100 4592403 http://www.medworm.com/index.php?rid=4577908&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2011%2F03%2Fbest-vs-worst.html No further rigors, no idea what the source was. Slightly worried I'm harbouring something nasty... but declined investigation so I guess I have to lie in my own bed.Increasingly find myself gripped by malaise, and dark feelings of hopelessness, which is somewhat self-indulgant considering my situation versus how it could be.Anyway, blame that for this post.In general, I have a low opinion of humanity. Essentially, I don't think we're as far removed from the beasts as we like to think we are. Left to our own devices, I think most people will happily crap on their fellow man, if it's to their own advantage.Altruism, generosity seem to me to be the exception.La Belle Fille firmly believed quite the opposite; she does have a bright shining soul though. She may be right.I suspect my job biases ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=4577908 Sat, 12 Mar 2011 14:51:00 +0100 4577908 http://www.medworm.com/index.php?rid=4532215&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2011%2F02%2Fyou-shall-not-pass.html One of, if not the most difficult things I have to do is watch people die.This, clearly, is never easy, unless you're a psychopath. (I am not)Sometimes, it is expected; after all none of us live forever, and so sometimes it doesn't feel so bad. Especially if you can make that passing as easy for all concerned as possible, and sometimes you can.But sometimes, you have to watch people die in the knowledge that they shouldn't be dying, and worse, that you don't know why they are, or that you can do nothing for them.Because what we're supposed to do, is stand there, Gandulf like betwixt patient and death. Only sometimes, you're not a wizard, you're an impotent old man, with a wispy beard.This happened once before when I was here before, in a different time, or a different life. We then, and st... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=4532215 Sat, 26 Feb 2011 12:50:00 +0100 4532215 http://www.medworm.com/index.php?rid=4352718&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2011%2F01%2Fhard-times.html Sometimes shit just happens.I know this to be true, and mostly use it as a defence, to protect my fragile mind, but sometimes, sometimes, things leak through. No man is an island, and this man certainly isn't a rock.The Christmas period was as horrendously busy as I've ever seen it, and I've worked a few Christmases. The rest of the hospital seems to operate a fingers-in-ears policy; interestingly, a few weeks after Christmas, when all the patients we'd seen had been admitted, and the burden of care was shifted up a level, 'they' sat up and took notice.Suddenly we were flooded with extra staff, and, as is so often the way, they came on a day when we had precious little to do, having admitted all the sick patients in the area.Until, of course, after 6 p.m., when everyone goes home.Except, m... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=4352718 Sat, 15 Jan 2011 13:59:00 +0100 4352718 http://www.medworm.com/index.php?rid=4207336&cid=t_119628_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F11%2F28%2Fthe-man-who-did-not-take-his-medicine-and-the-dog-who-saved-him%2F Today’s guest post is by Dr. Olajide Williams, a general neurologist with special interest in stroke. He is Associate Professor of Clinical Neurology at Columbia University. The following story is an excerpt from his book, “Stroke Diaries,” which is a collection of his experiences, both somber and hopeful. I find this piece on Oxford University Press’s blog, which you can get to by clicking here. Pedro was lying on the bathroom floor next to the toilet bowl. Water was still running from rusty faucet, overflowing the sink, and pooling around his body as he lay limp on wet porcelain tiles. Lucy was standing over him and whining. The young black Labrador retriever had not left her owner’s side since the previous night. It was as if she had predicted it, as if sh... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4207336 Sun, 28 Nov 2010 18:50:34 +0100 4207336 http://www.medworm.com/index.php?rid=3794845&cid=t_119628_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F07%2F27%2Fbest-of-our-blogs-july-27-2010%2F This weekend I got in touch with a different side of my personality: the nature loving one. It’s the part of me that often gets buried underneath daily worries, fears and your garden variety neuroticism. While tending to issues are important, so is taking a break from them. Based on the outpouring of responses I got concerning outdoor activities on Facebook, it seems like I might not be the only one. Isn’t it nice basking in the ray of hope and possibility instead of fear and uncertainty every once in awhile? That’s what I spent my time doing in a rustic cottage in the country. I stared out the French doors of the tiny cottage for several minutes without fear of boredom or anxiety from doing nothing. I heard and felt comforted by the subtle soundtrack created by the soun... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3794845 Tue, 27 Jul 2010 11:36:06 +0100 3794845 http://www.medworm.com/index.php?rid=3567942&cid=t_119628_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F05%2F15%2Fgo-to-your-graduation%2F Our regular contributor and one of the therapists here at Psych Central, Marie Hartwell-Walker, Ed.D., has a great new article entitled, Yes, You Should Go to Your Graduation. It’s worth checking out if you’re a student facing the imminent graduation ceremony, or a parent of such a student. From mid-May well into June, my corner of the world is celebrating one graduation after another. With four colleges, a state university, two community colleges and more high schools and alternative schools than I can count within a 25-mile circle around my town, the hills are alive with the sounds of “Pomp and Circumstance.” It’s the season when graduating seniors wear funny hats and walk across a stage or field or gym floor after what seems like an interminable wait. It’s a time whe... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3567942 Sat, 15 May 2010 16:46:04 +0100 3567942 http://www.medworm.com/index.php?rid=3302321&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2010%2F02%2Frode-into-nazereth.html I have had to admit, or at least refer for admission, a number of patients recently in a genuine display of Cover Your Ass medicine. I hate practicing CYA medicine, and yet it seems to form an increasing part of my practice. Evidence Based Ass Covering.Increasing seniority brings with it a diminishing ability to be wrong. Mistakes are allowed, almost expected of junior staff, and as long as they aren't disastrous... well, you know what I mean.However, the ever increasing pressure of the 4 Hour target (All Hail) gives me less and less time to think about what's wrong with, and what's best for my patients.And so, I end up referring those folks who just aren't right. I am losing faith in my clinical acumen, because I know I can't always be right, and I can't afford to be wrong.Of late I have ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=3302321 Sat, 13 Feb 2010 22:18:00 +0100 3302321 http://www.medworm.com/index.php?rid=3266915&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2010%2F02%2Fand-death-followed-after.html More evidence, if any such was required, that I attract trouble, that I am a 'Black Smoke' Registrar.'Twas darkest night, tho the moon shone bright (which may be oxymoronic), when the clock struck shit.That's right. I said the clock struck 'shit'. I would like to propose the term 'shit o'clock' to represent the time in the Department when the shit hits the fan. I suppose 'arse o'clock' would be acceptable, or indeed 'trouble o'clock', if you are less foul mouthed.Anyway, all had gone just fine, until shit o'clock.The BatPhone rang trilling of the impending arrival of a young sailor who had fallen 20 feet from a gate, part of which had detached itself and landed on his leg. He had, somewhat amazingly, avoided other injury, but as we peeled back the splinting on his lower leg, it became appa... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=3266915 Wed, 10 Feb 2010 00:09:00 +0100 3266915 http://www.medworm.com/index.php?rid=3167123&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2010%2F01%2Fmissed-it-2.html A healthy dose of schadenfreude.A patient with end stage COPD rolled in. She also had a pulmonary malignancy, for good measure. The usual story - gradual deterioration, struggle to manage at home, sudden failure and collapse.The Ambos reported low sats, recovering with hi-flow oxygen, but a fall in GCS concomitantly.We see this a lot. I raised my eyebrows, ran the ABG. Acidotic, pCO2 15, pO2 15; both too high, too much O2. Turning it down, we aim for sats in the raange 88-92. Air entry thru the chest is poor, tight. I put it down to COPD, rack up the nebs, quietly confident.We'll have her up and running in no time.10 minutes later, I'm wrong. She's gone downhill fast; cyanosed, moribund, circling the drain. Fortunately, the X-Ray fairies have just been, and I gaze at the film.Pneumothorax.... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=3167123 Mon, 11 Jan 2010 22:30:00 +0100 3167123 http://www.medworm.com/index.php?rid=3167124&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2010%2F01%2Fmissed-it.html A lot of what we do is pattern recognition. With experience, our diagnostic process moves from the 'scattergun' approach to the focussed, guided by the signs, subtle or obvious.Often, we rely on bypassing a lot of 'routine' or standard investigation, if the pattern before us stands out strongly enough. Sometimes the pattern shouts at you. An 'end-of-the-bed' diagnosis.Of course, not all disease choses to present that way. Sometimes the obvious is not what it appears, and sometimes, perhaps often, the presentation is atypical.Sometimes it's not.A young man with a few week history of general malaise. Tired, weak, off his food, weight loss. Even a dose of oral thrush. Three days before, he had taken to his bed, nauseated, vomiting, listless.He lay on the bed, looking like nothing more than a ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=3167124 Sun, 10 Jan 2010 22:19:00 +0100 3167124 http://www.medworm.com/index.php?rid=3153372&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2010%2F01%2Fzombie-apocalypse.html More evidence, if any were needed, that Great Britain can't cope with snow. And, latterly, that every time I agree to swap shifts with someone, it goes tits up...Tuesday, two days ago, I should have been on a day off, but had agreed to cover a shift for a colleague. It was the swing shift, 4pm until 1am.By just after 6 it was snowing pretty heavily, but didn't seem to be settling. By about 8 it was lying thick on the ground, and the flail had begun. Cars were getting jammed on the roads, big and small, and even the Ambos were getting trapped. It rapidly became apparent that no-one who couldn't walk home was getting home.This clearly included me.The only upside being that if we couldn't get out, no-one could get in. Ambulances couldn't even back into the Bay, a distance of some 10 feet, up ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=3153372 Thu, 07 Jan 2010 23:30:00 +0100 3153372 http://www.medworm.com/index.php?rid=3137492&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2010%2F01%2Fwhat-would-you-liike-me-to-do.html An interesting shift; not as busy as I thought it might have been...There is,as many of you will know, an ongoing struggle for us in the ED to convince our Specialist brethren that once in a while, we know what we're about.I saw a young woman yesterday, with a long, complex history; the sort of history that makes life difficult for you - a mixture of physical and psychological, God-given and self afflicted. She has had many admits with belly-ache, and mostly managed with difficulty.Yesterday she presented a week after taking a substantial overdose of tramadol, complaining of abdominal pain and an inability to open her bowels. So far, so constipation; except that her pan was uncontrollable (which may represent real pain, or simply a desire to obtain more morphine...) her pulse racing, and h... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=3137492 Sat, 02 Jan 2010 16:26:00 +0100 3137492 http://www.medworm.com/index.php?rid=3029802&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F11%2Fcometh-hour.html I have found this difficult to write about.I suspect that we all, at one time or another have confronted our worst fears, either really, or in our minds. If you haven't you should.It still might not be enough.To me, an Emergency Physician is one who knowswhat needs doing, and how to get it done, in any given situation. Frankly, most of what we do, most of medicine, is not time critical... in as much as you can spend a few minutes mulling over your options.The way I see it, my paycheck is the massive hoard it is because once in a while we don't have that luxury.Imagine this.Let us say a patient has been brought to you, having arrested out of hospital. They have survived, which is, in itself, a rareity. But they are now unmanageable, and need 'optimising'. In short they need their physiology... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=3029802 Wed, 18 Nov 2009 10:57:00 +0100 3029802 http://www.medworm.com/index.php?rid=3003768&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F11%2Ftaking-ones-eye-off-ball.html The targets we must labour under continue to insert themselves into out minds, insidiously, until we think they've always been there.Where I currently work, there seems to be a strangely blase attitude to some of the stuff that comes in on the BatPhone, and I can't help but wonder if that's because we know they've got 'plenty of time'. Of course, they might die during that time, but, hey, at least they won't breach.Maybe I'm wrong, and, of course, this is not the party line, but I keep finding patients in Resus, with no Doctor. Most recently was a fella found by his flat mate, unconscious. He was still unrousable on arrival at the ED, and went almost an hour before being formally assessed by a Doc. He ended up tubed and on ITU.Now, maybe that's just me; no-one else seemed overly bothered, ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=3003768 Wed, 11 Nov 2009 12:58:00 +0100 3003768 http://www.medworm.com/index.php?rid=2967340&cid=t_119628_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F11%2F06%2Fbest-of-our-blogs-november-6-2009%2F I’m attending the 25th Annual Rosalynn Carter Symposium on Mental Health Policy today, and I’ll write more about the inspirational work this organization has been doing for 25 years shortly (not just in Georgia, but throughout the entire country). The people who are attending this symposium — as well as the Carter Center itself — have done much to improve mental health care in the U.S., but it’s not something you hear enough about. It’s heartening so many great minds coming together to share best practices and ideas for improvement (especially at this unique time in healthcare history). Not just policy wonks, but also physicians, mental health practitioners, administrators, consumers, CEOs, you name it — they’re all here. All talking about wa... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2967340 Fri, 06 Nov 2009 15:06:23 +0100 2967340 http://www.medworm.com/index.php?rid=2971886&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F11%2Fneeds-of-few-vs-cost-to-many.html One of the problems with trying to adopt an evidence based approach, to anything, but in particular, to medical testing and treatment, is that population studies do not tell individual stories.The problem with using individual stories is that the plural of anecdote is not data, and association does not prove causation.However....A young middle-aged woman with chest pains present to the ED. They had woken her from sleep, but been transient, and she had gone back to sleep. In the morning she had something of a dull ache behind her breastbone, and felt a little short of breath. Simple remedies had not helped. Her pain had settled at time of exam, and she examined normally. An ECG was normal.Past history, family history, all negative.How to proceed?She was admitted for observation and serial c... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2971886 Fri, 06 Nov 2009 13:18:00 +0100 2971886 http://www.medworm.com/index.php?rid=2967284&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F11%2Fsudden-and-unexpected.html It's amazing how much better I feel having finished my exams. Conscious of the stress as I was, I'm still surprised to see how much better I feel, with them over. Of course, now I have to wait 3 weeks before learning of my fate,and possibly starting all over again.Ah, well...LBF has had to endure more than her fair share of deprivation, and I hope that now, we can spend more time making mischief. Although, of course, my rota may well continue to get in the way. She has been somewhat under the weather of late, but, having undergone emergent needling treatment, and something to do with balls in ears, is feeling more like her old self. Which, in case there was doubt, is witty and funny. (Almost always)Anyway; the ED is often witness to the unexpected; as it should be, really. Almost by defini... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2967284 Thu, 05 Nov 2009 18:30:00 +0100 2967284 http://www.medworm.com/index.php?rid=2934768&cid=t_119628_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F10%2F27%2Fpatient-stabs-doctor-shot-dead-at-bipolar-clinic%2F A patient being seen at the Massachusetts General Hospital’s Bipolar Clinic and Research Program attacked his physician today, stabbing her with a knife during a treatment session according to Boston Police. The incident occurred in an office building nearby the main Mass. General building, where the hospital leases space for the Bipolar Clinic: After at least one gunshot echoed on the fifth floor, two nurses from [a neighboring] office went to treat the patient, who had apparently been shot in the head by the security guard [...] “During the course of the stabbing incident, an off-duty security officer who was armed interceded,” [Police Commissioner Edward F. Davis] said. “He produced a weapon and ordered the suspect to drop the knife. When the suspect did not co... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2934768 Tue, 27 Oct 2009 20:38:36 +0100 2934768 http://www.medworm.com/index.php?rid=2894508&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F10%2Flearning-on-job.html There are, it seems, some lessons you have to keep on learning. Unlike to aphorisms pertaining to those in possession of a blue rinse, or wearing sunglasses indoors, at night, some things keep cropping up.Lesson One: History is importantWe are taught this almost from day one at medical school. Diagnosis is mostly in the history, and the skill, the art, is in teasing out those details that give you the answer you seek, while ignoring the dross, the red herrings. Refining the art allows this to be done at speed. You might call it pattern recognition. I like to think I'm good at it.And yet...She fell at home, a simple fall. What we call a 'mechanical fall', much to the consternation of my Physician colleagues. She bumped her head, but did not black out. An Ambulance attended, the Paramedics f... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2894508 Wed, 14 Oct 2009 18:29:00 +0100 2894508 http://www.medworm.com/index.php?rid=2871622&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F10%2Fmemories.html Memory is a curious thing. It is almost infinitely plastic, and malleable. We can play with our memories, and over time convince ourselves our version of the truth is more real than someone else's. Even with insight we spin and play events, trying them out for size.History is written by the victor, and memory is constantly re-written by our subconscious, seeking the most palatable version.Earlier this week, a patient was brought to us from a hostel; he had been staying there for some sort of reunion. He had collapsed, perhaps losing consciousness briefly. All he could say was that he felt unwell.He looked bloody awful. Pale, clammy, breathing fast and shallow, pulse strong, but fast. The sternotomy scar announcing his membership of the cardiac club. His sats were low, but not catastrophica... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2871622 Wed, 07 Oct 2009 11:11:00 +0100 2871622 http://www.medworm.com/index.php?rid=2865662&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F10%2Fspare-chaynge.html Our attitude to death, or Death, if you will, constantly fascinates me. I suspect it is, at least in part, related to the secularisation of society. I think people fear death considerably more now they aren't assured that it means going to paradise to meet one's maker. Coupled with the idea that we can do so much to stave off death, this seems to me to have resulted in a world where we no longer accept that death comes to us all, and devote much time and money to prolonging the inevitable.Even when this has been accepted, people seek to transfer the responsibility to someone else, usually the medical profession, often me, because I stand by the front door.Last week, among the throng that seems to be increasingly the norm at South Coast General, and this is only the beginning of Winter, wer... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2865662 Tue, 06 Oct 2009 15:42:00 +0100 2865662 http://www.medworm.com/index.php?rid=2851772&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F09%2Ftoo-late.html She came too late...I don't know why, but I guess she was scared.Afraid of what we'd tell her.Afraid of what we'd find.Maybe it didn't seem that bad?Maybe she lacked the wherewithal to know better.She fell at the exact opposite end of the spectrum to those folks who bump their heads on a car door while getting in, and pitch up complaining of a 10/10 headache. They end up with a CT scan that undoubtedly does more harm than good.She got the full force of medicine and surgery, and it still wasn't enough.She came too late. (Source: The KnifeMan) The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2851772 Wed, 30 Sep 2009 23:04:00 +0100 2851772 http://www.medworm.com/index.php?rid=2846367&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F09%2Fsuffer-little-children.html Considering I spend all day dealing with people, I occasionally find them surprisingly annoying. Sometimes, I might suggest, this is well deserved - the pisshead who thinks it's funny to take a crap on the floor, for example. Sometimes, I think it's probably futile. People are the way they are, and I'm not sure i can blame them for that, any more than I might scold a cat for eating a mouse.Children, specifically teenagers, and their parents are among the leading perpetrators.Consider:If you think you are old enough, are mature enough to get drunk, go skateboarding au naturel, and then fall on your head, you should be mature enough to accept that your treatment will have to be in hospital, that a cervical collar is a bit uncomfortable (tho only for a bit, and much less uncomfortable than 60... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2846367 Tue, 29 Sep 2009 23:37:00 +0100 2846367 http://www.medworm.com/index.php?rid=2846368&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F09%2Fone-by-one.html South Coast General provides pathology, thick and fast. One by one, sometimes all at once.Today's shift provided more good evidence that empiricism lets you down. A fella came to us, pinged ahead by the MobiMed, a computer link up with the Ambos, allowing them to flag patients and their ECGs. Telemedicine, I guess we should call it.It offers real time comms with the Ambos, and sometimes, the opportunity to see the poor buggers go off, en route, in real time. The first message forewarned of a patient with a headache and left-sided weakness. Otherwise, stable, so far, nothing so unusual, unfortunately. Within minutes, they pinged back. His Glasgow Coma Score had dropped to 5. This is a score ranging from 3 (which even a corpse would score) to 15. 5, you can deduce, is bad.Minutes later, he h... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2846368 Mon, 28 Sep 2009 23:32:00 +0100 2846368 http://www.medworm.com/index.php?rid=2823985&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F09%2Fgiving-it-all-youve-got.html One of Shroom's tricks manifests itself as pessimism. I prefer to think of it as realism, but it's really pessimism.My reasoning runs thus: many of my patients will be in extremis, and I may well know their fate before they do. Worse, it may be obvious that, no matter what I do, the outcome will be grim.So I try not to get my hopes up. This is not to say I don't go Full Tilt Kozmic Boogie, where it's apt, but thatI steel myself to the idea that despite it all, they're going to meet their maker.It just hurts more when you invest a bit of your soul in the belief that they might just be ok.Maybe this makes me less of a human, but that's how I choose to cope.For example: a few days ago, a fella arrived, clapped out, with a history that screamed 'ruptured aneurysm'. A man of middling years, wit... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2823985 Tue, 22 Sep 2009 22:57:00 +0100 2823985 http://www.medworm.com/index.php?rid=2670810&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F08%2Fset-adrift.html On leave, so not much medicine. La Bell Fille is away, living it up, demonstrating that, yes teachers get beater holidays than doctors, but that they are also better at managing their money than, at least, this doctor.If I think I'm underpaid, don't get me started on teachers.Seriously, how important do you think education is?The amount people pay for 'private' education answers the question.It's just a shame, as with pay per service health care, that we (the high earners) don't want to pay for everyone to have the good stuff.Last shift before leave, a night shift I swapped with Giganticus. It was, with a certain degree of inevitability, awful. Had to call the Boss in - first time in years. Multi vehicle pile up. Nothing we couldn't deal with, but the waiting time was going to go to shit, ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2670810 Tue, 04 Aug 2009 23:42:00 +0100 2670810 http://www.medworm.com/index.php?rid=2660732&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F07%2Fbe-careful-what-you-wish-for.html On minor irritations, and major catastropheI know I need a break when I become more irritable than usual; this doesn't take much, to be fair. One of my colleagues, through no fault of their own, has begun to irritate me hugely, and, more or less, whatever they do.I need a break.Then everyone started to irritate me.I need a break.Last night dragged, dragged on and on. I found myself wishing for something interesting, something... acute. Something to set the adrenaline on edge. Something to set against the seemingly never-ending tide of people who should know better. People who think they can stroll into my place of work, roundly abuse me for 10 minutes straight, than apologise, and it will all be o.k.People who really think drinking until they piss themselves and vomit on me doesn't need an... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2660732 Sun, 26 Jul 2009 11:09:00 +0100 2660732 http://www.medworm.com/index.php?rid=2605978&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F07%2Fvon-gogh-genius-or-digitoxic.html There isn't a great deal of connection betwixt title and post.Again.I'm currently listening to more Janis Joplin. You should too.I'm also bricking it at my impending exam; but more of that later.A few snippets:Crane ManA peaceful dayshift was interrupted recently; there is a massive building site outside the ED at present, and it's main 'feature', if you will, is a mahusive crane. Of the sort that moves shit around, not a giant bird, wonder of the natural world, and envy of other flying dudes the world over. The site is well locked up, and it never occurred to us that someone would break in... I can't think why we were so naive.Crane man took against the world, and decided to make his stand atop the mighty metal edifice; which made conversation difficult, as shouting a hundred feet up into... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2605978 Wed, 15 Jul 2009 21:29:00 +0100 2605978 http://www.medworm.com/index.php?rid=2553028&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F06%2Fon-perspective.html I do have a serious (ish) point to make; but the heat is making me sluggish. Everything seems a bit harder when it's this close and muggy. Even my coffee mocked me this morning - the milk looked good, smelled ok (ish) and, on adding to coffee, seemed good.Sadly, it tasted like shit.So, a few days ago, you will have noticed - unless you live in a cave, or are deaf dumb and blind, and spend all your days playing pinball - someone famous died.Well, two, really. Farrah Fawcett, and Michael Jackson both shuffled off this mortal coil. On La Belle Fille's birthday, as it happens, but I'm sure that was a coincidence. Farrah's death slipped by me un-noticed. Not entirely surprising, as her people have no real reason to keep me in the loop.Jacko, on the other hand, was a different matter altogether.... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2553028 Mon, 29 Jun 2009 15:28:00 +0100 2553028 http://www.medworm.com/index.php?rid=2458096&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F06%2Fque-sera-sera.html We all waited, out front. When I worked in London, we used to wait for the Ambos most of the time, but we don't seem to do it so much here. Maybe just when we think it really maters.The weather struck an odd balance; it was glorious, warm air, cool, crisp skies. Quiet, while we waited. Everyone's faces around me very serious, very drawn; I wondered if I looked like that. Too much thinking in the quiet time might drive you mad; fortunately, we don't have long.We hear them first, and that's never a good sign; usually the sirens go off as they roll up the ramp; if it's proper bad, they stay on blues and twos until the last minute...The door opens, more or less on the fly, and they're asking for help in back; this is also bad - the Ambos never ask for help - they don't need to.I jumped in, and... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2458096 Thu, 04 Jun 2009 21:04:00 +0100 2458096 http://www.medworm.com/index.php?rid=2386952&cid=t_119628_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F05%2F03%2Fif-only-keeping-you-stuck-and-frustrated%2F Two words. Six letters. So much potential for destruction. You say it to yourself and so do I, sometimes without even realizing it. Do you even realize how powerful it is? If only I had more time, I would exercise. If only my parents weren’t so annoying, I’d be less stressed. If only I had a bigger house, then I’d be more organized. If only, if only, if only…You know, it isn’t just the “if only” part that is so damaging. By itself, it just a harmless wish or fantasy. It’s saying “then”, as if you only have permission to have this better outcome when the first part happens. Let’s break this down once, shall we? Take the example about having a bigger house and being more organized. I threw this one in for me. We still live in... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2386952 Sun, 03 May 2009 16:44:08 +0100 2386952 http://www.medworm.com/index.php?rid=2353799&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F04%2Fgod-dont-play-dice.html Fair is an unusual concept in life, and yet one that we return to all too often.For all the people we see in the ED who have stubbed their toes, who have a bit of a sore throat, who used a lump hammer to smash stuff and wonder why their shoulder aches, for all of the 'worried well', there are a dying breed who don't like to make a fuss; who feel that they are 'bothering' us at work.Geoff was just such a man. Yesterday evening, while lugging heavy bags of compost about, he developed a pain in his chest. He described it as like having someone pull your tongue out by the root. It shot from his chest to his belly, and wa accompanied by explosive diarrhoea. He remarked on the pain to his wife, but didn't want to trouble anyone.He took himself off to bed, where the pain got worse and worse; he b... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2353799 Tue, 21 Apr 2009 21:17:00 +0100 2353799 http://www.medworm.com/index.php?rid=2353802&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F04%2Fnights-part-two.html In retrospect.They were pretty decent actually; low volume, but occasionally complicated patients. Working with one of the Charge Nurses who spent the evening cheering himself in an understated manner... this is difficult to convey with the written word, but try to imagine an ironic cheer: a sort of sarcastic, sotto voce 'hurrah'... but for yourself.Well I thought it was funny.Maybe you had to be there.Satisfaction came, as it so often does, in the form of two sickies. The first, in the late afternoon of life, with chest pain and an ECG that told all we needed to know, its ST segments sagging painfully in the anterior leads, dragging themselves up inferiorly. He was holding it together, just barely, his skin a grey sheen, his breathing ragged, and forced. I called Cardiology down, again, p... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2353802 Tue, 21 Apr 2009 19:35:00 +0100 2353802 http://www.medworm.com/index.php?rid=2227518&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F03%2Fif-i-ventured-into-slipstream.html Managed to survive nights; again.Something of a week for stabbings. I've seen six since I've been at South Coast Hospital. I suspect my North American readership will sneer at this, since, if t.v. is to be believed, every shift in US EDs is a stabfest. Anyway, it's a big deal for me. Five of the six have been in the last week.Number three was perhaps the most eventful. Young fella, stab to the epigastrium. Over the phone, his obs didn't sound too bad - lowish BP, normal pulse. 'Course, its all relative, but I worry about the young ones that are tachy more...These calls are always a bit like Schrodinger's Cat. Until they arrive, they might be really sick, or not too bad; so they exist in a kind of quantum state in between. Then they arrive...It didn't take a modern day Astley Cooper to figu... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2227518 Mon, 02 Mar 2009 12:10:00 +0100 2227518 http://www.medworm.com/index.php?rid=2206818&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F02%2Fmack-knife.html It is a curious phenomenon, oft observed in buses, that one waits for ages, then 3 come along at once.And so it is sometimes in the ED...While we get our fair share of trauma, we don't see much knife crime, and almost no gun crime. This last weekend, we got all our knife wounds at once. It's always slightly concerning when two fellas pitch up in short order, with similar sounding wounds. Not only does it raise concern that the Department might struggle to cope, but furthermore, that the two might have wounded each other - in which case, bedding them down next to each other in Resus is ill advised.In this case, while I suspect the two wounds might have been related, they certainly didn't seem to have been inflicted mano y mano.Number one had what I think of as the disemboweling cut - a tran... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2206818 Mon, 23 Feb 2009 17:34:00 +0100 2206818 http://www.medworm.com/index.php?rid=2113663&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F01%2Fcrazy-man-michael.html Another night passes. The promised 'thundersnow' has not materialised, at least not this far South. The weather was pretty shite, tho. I approached the shift with significant trepidation; my nerves clawing at the inside of my belly all the way down, leading me to wonder, at one stage, if I really had cooked my pork chops properly...I can't stop revisiting the cases from the night before, and head straight for the information superhighway that passes as the hospital intranet as soon as I arrive. The fitter has had all the investigations and treatment I didn't instigate. All to no avail, which is some consolation. Maybe I was right.I mull this over, and chew the fat with the SHO I ran the case with. He is more robust in the defence of our management, and I wonder if that's because I know mor... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2113663 Sun, 18 Jan 2009 19:29:00 +0100 2113663 http://www.medworm.com/index.php?rid=2112367&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F01%2Fdouble-or-quits.html Some days it feels like you can't do anything right.Last night started benignly enough, but midway through the night came to a unpleasant crossroads. Resus had been the stopping off point for a couple of teens who couldn't handle their beer. They both came round fair enough, with one taking a little longer than t'other... I still think he was on drugs, but I guess that's his business.The Ambos broke the reverie of the ethanolic miasma by bringing in a young diabetic, unwell and sinking fast. His diet, eschewing food for vodka and coke, not helping. He was pallid, restless and crispy dry, reminding me all too well of the last diabetic I had in resus. Ketoacidotics are unwell, for sure, but there's degrees of unwell.This fella was first class unwell; sick, with honours, if you will. He start... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2112367 Sat, 17 Jan 2009 19:22:00 +0100 2112367 http://www.medworm.com/index.php?rid=2112368&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F01%2Fwhat-next.html 22 year old male, previously fit and well, presents at 4 in the morning. The previous evening he had had a curry, but nothing unusual. A few hours later he had begun to feel unwell.He described epigastric pain, associated with nausea and vomiting. He had had no change in bowel habit, and there was no blood or bile in the vomitus.He had had no recent foreign travel, denied drug ingestion, and none of his friends were unwell.He was afebrile, warm at the edges and cardiovascularly normal, and stable.Abdominal exam was untirely normal, routine blood tests and radiographs were normal.As his pain had required opiate analgaesia, he was boarded on our obs ward for several hours.Repeat exam some four or five hours later remained normal. His observations had been stable, and his pain had settled. He... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2112368 Sat, 17 Jan 2009 19:14:00 +0100 2112368 http://www.medworm.com/index.php?rid=2104686&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F01%2Froom-for-small-one.html The Crisis continues...The Hospital is full; yesterday an 'internal' Major Incident was declared. This sparked brief panic, as word spread around the Hospital. For those not in the know, a 'Major Incident' is usually declared in response to a sizable disaster - plane crash, train wreck, etc. The implication is that incoming workload will swamp the Hospital's ability to cope. An internal incident simply means we can't cope with the routine workload of the day...While the difference between the two was sinking in, a variety of anaesthetists and intensivists pitched up, looking for work, causing more confusion, as most of us hadn't been told about the move to Defcon 2, or whatever it's being called these days.As far as i can tell, a lot of Very Important People were summoned to the Department... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2104686 Wed, 14 Jan 2009 12:21:00 +0100 2104686 http://www.medworm.com/index.php?rid=2094923&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F01%2Fdoctor-my-eyes.html Never let it be said I am prone to hero worship, or hyperbole.But, I witnessed the most remarkable act of resuscitation recently. It has to be said that I should probably have been less impressed, because, really, it should be bread and butter, but...The calls on the BatPhone always bring a frisson of excitement to a resus junkie like myself. We got two in short order, both elderly, both low GCS. One carried a warning of low pulse, the other of high BM. Daytime brings high staffing levels, relatively speaking, so the first contestant went to one of the bosses and an SHO; patient didn't look too bad when she rolled in, so I left them to it and tried to prep for number two.High sugars and low conscious level smells like diabetic ketoacidosis and cerebral oedema to me, and it ain't a nice sme... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2094923 Sat, 10 Jan 2009 23:50:00 +0100 2094923 http://www.medworm.com/index.php?rid=2081198&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F01%2Ftears-of-clown.html The year rolls on, with barely a backward glance.Big teaching hospital is creaking at the seams righ now; and not even under the weight of Le Morse and his visitors trooping up to glare at the ENT wizards. He's gone home, hurrah, and speedy may his recovery be.No, it is the winter, and the cold spell it brings. This year has been especially rife with 'viral infections' and the elderly, or infirm - mostly with chronic lung conditions - have fallen from their perches in droves.Result: Full hospital.Consequence: My ED now regularly resembles a battleground. It doesn't take a genius to foresee it, really. If we see between 200 and 300 a day, and even half of them are majors patients, that equals about 5 ambulances arriving every hour. We have 16 cubicles (count 'em) and 16 obs beds, give or ta... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2081198 Mon, 05 Jan 2009 13:36:00 +0100 2081198 http://www.medworm.com/index.php?rid=2078306&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2009%2F01%2Fdulce-et-decorum-est.html Whatever we may think, however we may feel, being a Doctor represents considerable priveledge. We are party to the best and worst of other people's lives. We are granted power tha other people are not, and charged with exercising it responsibly.Perhaps greatest among these are the rights granted us under Common Law, by the Doctrine of Necessity. It enables me, however briefly, to supercede your wishes, to act on your behalf, sometimes in direct contravention of your stated desire.In practice this is usually when someone is incapacitated, and unable to express their wishes, but, on occasion, it is despite your active rejection of my proposed plan of action.In overdose, for example.It should, and does, weigh heavily, on my mind to do this.If ever I needed reminding of why this is not entered... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2078306 Sat, 03 Jan 2009 13:50:00 +0100 2078306 http://www.medworm.com/index.php?rid=2074626&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F12%2Fmedical-miracles.html By and large, I don't believe in miracles. I am a vaguely religious man, so I'm sure they're possible. I just think the phrase is rather over-used, and had come to mean an unexpected, improbable outcome, not a true miracle.Still, on Christmas morning, I found myself waiting in Resus, checking the kit. The call didn't offer much hope. An elderly patient, visiting family for the holiday, had fallen down the stairs. No output with the Paramedics. This sort of call tends to be an 'in-and-out' job. If they haven't got an output back by the time they get to us, they probably aren't going to. And while the NHS isn't ageist, God is, I'm afriad. Your chances of surviving cardiac arrest are not improved by being over 80...Despite my fears, six minutes later, we were greeted with a bounding pulse. A ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2074626 Wed, 31 Dec 2008 15:34:00 +0100 2074626 http://www.medworm.com/index.php?rid=2035913&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F12%2Fparanoia-strikes-deep.html Yesterday morning was spent trying to talk down a spectacularly paranoid fella, who, when he wasn't freaking out because he thought he was blue, was challenging my status.His exact words?"I'm not being funny, yeah, but I don't even think any of you are real doctors. I mean, you're all wearing trainers, for f.'s sake!" (Source: The KnifeMan) The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=2035913 Tue, 02 Dec 2008 05:48:00 +0100 2035913 http://www.medworm.com/index.php?rid=1961035&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F11%2Fhighs-and-lows.html Back, at least for a while. I had intended to wait a day or two, to refit my life all at once; but this idea came to me, and I felt i ought to write it before I lost my mojo again.I am become a creature of the twilight; lates and nights stalk my rota, and I've forgotten what a normal day looks like. I'm sitting among the detritus of my life that late shifts bring, drinking rum, if that helps.Sometimes, I feel like we make a difference; sometimes I'm sure we don't. But I guess we try anyway.The first comes early; or late, depending on which end you're starting from. The shift is a swap, and horror often seeks you out on a swap. Whatever Gods look down ensure that no good deed shall go unpunished. Actually, the shift had been fine. I'd been cloistered in Paeds and Minors all night, my most c... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1961035 Fri, 14 Nov 2008 23:25:00 +0100 1961035 http://www.medworm.com/index.php?rid=1794553&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F09%2Fmy-promises-are-nearly-kept.html Saturday was unbearably busy; Sunday just unbearable. It was busy, I was irritable. The SHOs are hard working, God love 'em, but have a deal to learn about the appropriate time to strap on in Emergency Medicine. I'm not sure I helped much.The tone was set, not so much by Drs Greene or Carter, but by two patients. The first, a young man with his own version of a biological clock; his aorta distended, over-ripe lay swollen and pregnant within him. He knew it was there and had had the 'full and frank' discussion with his surgeon. Weighed the odds of success against the chance of failure and the consequences inherent therein. He had, he thought faced his demons, made his choice, and defended it. The ultimate act of self determination.Funny how circumstances can change a body's perspective. Eac... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1794553 Mon, 15 Sep 2008 23:18:00 +0100 1794553 http://www.medworm.com/index.php?rid=1546832&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F06%2Fon-top-doggy-and-normal.html A Tale Of Three...You came first; reluctant, disgruntled. A familiar ale, of a rough struggle in the night, steel toe-capped boots leaving their angry retort. A litany of complaints, of your head, your neck, your chest and your shakes. We saw you immediately. You argued with us then, unhappy at your confinement, unwilling to see the necessity... we explained, cajoled. You swore and threatened. We hoped it was your head injury... it was just you. We cleared your neck, offered pain relief, albeit not the opiates you wanted, eased your shakes. It wasn't enough. We were too slow to bring you the coffee and sandwiches you wanted. You told us you couldn't walk, couldn't see, couldn't turn your head. But when no food was forthcoming, you got up, looked around, offered one final charming epithet a... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1546832 Thu, 26 Jun 2008 12:58:00 +0100 1546832 http://www.medworm.com/index.php?rid=1518887&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F06%2Fcross-is-in-ballpark.html There are very few moments in my job when I feel real fear; I see a lot of unpleasant things. I see a lot of sick people, and many of them make me anxious, because I'm always thinking the worst. But that's what I'm there for. Get on and treat.But sometimes, something will happen that makes me pause, that sucks the breath right out of me. A time when you begin to think you might not have whistled loud enough on your way past the graveyard.Perhaps this will clarify:Last night began humourously enough; I forgot my scrubs, so borrowed a set from Sister. Dressed as I was in blue, everyone took the opportunity to look askance at me and call me 'Sister Shroom'. And it was honestly as funny the 20th time as it was the first.Then, in one of the surreal moments that EM throws up, our reverie was bro... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1518887 Sat, 14 Jun 2008 13:50:00 +0100 1518887 http://www.medworm.com/index.php?rid=1461144&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F05%2Fvoila-le-morse.html So, I'm lagging again. About a week behind. Good intentions trailing in my wake.The problem is, the longer you leave it, the blurrier the edges get.Last weekend (10 days ago now) wasn't so bad; along with the pressure of the trial period comes extra staff - which, shock/horror, moves things along a bit quicker - so a bit less for me... Saturday was tough; One of my favourite sisters was on... but she is a wee bit 'black smoke'. Her first words to me were: "It's not looking too bad..."10 minutes later, and resus is humming. Contestant number one has complete heart block, and is not at home to external pacing. Actually, we did get capture very briefly, but then our new all singing, all dancing defibs gave it up.I'm not sure I trust them. They talk to you, in a kind of mid-Atlantic accent, be... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1461144 Mon, 19 May 2008 22:27:00 +0100 1461144 http://www.medworm.com/index.php?rid=1437031&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F05%2Fpills-and-thrills-and-daffodils.html Normal service, it would seem, has been resumed.I had some bad news tonight - a friend, a very good friend has ended up in intensive care, after seemingly routine surgery. As best as I can gather, he is going to recover fully, but it's still a hairy time. Information is scarce - the Unit won't tell me much, as I'm only a friend, and everything else is second or third hand. I was keen to visit tomorrow, but his ma doesn't think he'd want us to see him like this.Probably true.At work, I've gone back to breaking people's heart's for them. A few days ago, a young lad was brought in from a 'low velocity' RTC. Everyone else involved walked away with out a scratch. Our patient sustained a major head injury, his CT showing the ugly white bloom of intra-cerebral blood, stark against the dull grey o... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1437031 Mon, 12 May 2008 00:00:00 +0100 1437031 http://www.medworm.com/index.php?rid=1389161&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F04%2Fburied-alive-in-blues.html Another Monday after nights, another bout of insomnia.I'm on an education day today, so non-clinical... supposed to be in work anyway, but since I've been awake all night (pacing, mostly) and the wonders of the Internet envelop my house, I've kinda taken an executive decision to stay at home. I imagine I'll get a bollicking for it, but what can ye do?In fact I'm becoming mildly concerned about my inability to adjust from nights, which seems to be getting worse weekly, but not sure what i can do, without resorting to pills - either sleepers to send me into the arms of Morpheus, or some sort of upper to get me goin' in the morning. I am reluctant to go down this road... so i guess I'll just have to slug it out. Ain't that so?(Etymology note - I think 'ain't' dates from early 18th Century Eng... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1389161 Mon, 21 Apr 2008 15:31:00 +0100 1389161 http://www.medworm.com/index.php?rid=1213327&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F02%2Flove-in-vain.html Unhappy post.Somedays, it's all just shit. Sometimes, you do everything right, and its still shit; sometimes you make things a bit worse; somedays it's all your fault.I'll have one from the top, and one from the middle, Matthew.We have new SHOs starting today. They're all called something new know. FY2 or ST1 or something. SHOs of varying experience. I worked with a couple of them today, and they seem competent enough. A few of them rubbed one of my colleagues up the wrong way; I find this basically amusing. I will enjoy the soap opera that is the bedding in time.Anyway: number one. A woman found by her son, slumped in her chair, not moving her left side. Several fits later she is at our door. Her blood pressure is high and climbing. She offers us no response, not even with determined teas... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1213327 Wed, 06 Feb 2008 22:56:00 +0100 1213327 http://www.medworm.com/index.php?rid=1196769&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2008%2F02%2Fburn-one-down.html Well, after five nights on the trot, you'd think I'd have something clever to write; or something intelligent; or thought provoking. Not really. My last few shifts have passed more or less without incident.Instead, departmental politics are once again at the fore. I have yet to hear what the Management Consultants who were prowling about have had to say. The breach targets are once again getting maximum billing. The next few months requires an extra big push. One more push, lads, and it'll all be over by Christmas!(Foundation! Foundation! Foundation! Arbeit Macht Frei!)The upshot of this appears to be that we are asked to organise referrals for our patients increasingly early. Not, and this must be emphasised, in a way as to compromise patient care however. I am becoming increasingly disil... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1196769 Sat, 02 Feb 2008 19:54:00 +0100 1196769 http://www.medworm.com/index.php?rid=1113644&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F12%2Fglass-onion.html It should be very telling that the highlight of my shift was putting two catheters in between 6 and 7 am...Regarding being careful what you wish for, I simply meant that before, I couldn't get a spare pair of hands for love nor money; but when the baby went off, so they tell me, every doc in the world drifted in to see if they could help. (Source: The KnifeMan) The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1113644 Sun, 23 Dec 2007 11:27:00 +0100 1113644 http://www.medworm.com/index.php?rid=1107086&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F12%2Fwhere-have-all-good-men-gone.html So; in addition to screwing the pooch by arriving 3 hours late for work (and having to confess to a five hour oversleep), I returned to my role as Angel of Doom.As part of my ongoing quest to establish my rep as the Resus Hog, I spent my entire night therein. Yesterday was particularly Code Blue-full. And we seemed to have a special on Paeds, too. Buy one, get one free - that sort of thing.Some days, one can't move for Docs milling around resus; somedays - no-one. At one stage yesterday, I had ownership of all tree resus bodies. Now, admittedly, they were patients who could tolerate being left alone for 5 minutes at a time. So I could attend to one, start treatment, go to the next, assess and treat, and so on. With good nurses, a body can just about manage. As I'm sure you can imagine, it ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1107086 Thu, 20 Dec 2007 13:30:00 +0100 1107086 http://www.medworm.com/index.php?rid=1100235&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F12%2Fall-wang-eyed-and-nowhere-to-go.html Further confirmation, if it were necessary, that i can, on occasion, function on bugger all sleep. But the drive back was... interesting. And although I feel dead on my feet, I'm very fearful that I will elude the arms of Morpheus again tonight. I don't think I can do it again.And so to work; it's man flu season. Even some of the female nurses were admitting to it. I'm sure that's 'bird-flu', but anyway...I guess I must have looked more pasty than usual; I sure as hell felt it. It was all I could do to not throw up when I got in. Sure, I can work on no sleep, but it ain't clever. Domperidone sorted that out. Resus was in full swing when I arrived. Baby blue pyjamas knows. He was there. I missed all the action, but did get a chance to relocate a posterior shoulder dislocation, something I h... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1100235 Mon, 17 Dec 2007 22:24:00 +0100 1100235 http://www.medworm.com/index.php?rid=1088788&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F12%2Foddments.html A multi-post. I had several good ideas on the way home, again; once again, I appear to have left them on the motorway.Last night was an odd one. Most Docs and Nurses were living it up at the ED Xmas do. Not me, obviously. The gremlins seemed determined to make the most of our discomfort, and so, for reasons I still do not understand, the temperature in the Dept fell steadily to a nice round 16 degrees (Celsius); or maybe it was 14. The corridors were lovely, toasty warm. But the treatment areas? Cold enough to freeze the balls off a brass monkey.(Bonus points for any of my dear readers who can suggest the origin of this expression...)I also began to suspect someone was playing silly buggers with the nitrous, as everyone spent more time than usual giggling. Or maybe I just had something on ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1088788 Wed, 12 Dec 2007 04:56:00 +0100 1088788 http://www.medworm.com/index.php?rid=1058402&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F11%2Friver-of-dreams.html In the middle of the night...Doing an extra night tonight for a colleague. Normally this would provoke a great deal of grumblage, but as it's because he's a new daddy, we don't mind. I sure as hell am getting old tho'. I used to be able to do a week of these and not feel it, but here I am after three, tired as a wet kitten, and irritable with it. Like a bulldog with a mouthful of wasp.Anyway...Further evidence, as if it were needed, that people throw off all sense of personal responsibility when they step through our door. Twice tonight I have had people gesticulating wildly at me, alerting me to the fact that they are bleeding.Not unreasonable, I hear you think. Well, no, not usually; but in these cases, the bleeding was from cannulation or venepuncture sites. Not from horrendous trauma, ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1058402 Wed, 28 Nov 2007 05:44:00 +0100 1058402 http://www.medworm.com/index.php?rid=1028272&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F11%2Fweekends-are-fun-right-3.html I'm actually a bit written out on this now.Sunday was proper shit. I left the department in a state, and it never recovered. Playing catch up was impossible. So, it was an unhappy return for me on Sunday night.Once again, my evening was dominated by Resus. This evening's specials were the very breathless. I find it odd how cases seem to come in a run. I guess it's because we only remember the runs. When 3 breathless punters come in one after t'other, it sticks. 3 different cases doesn't seem such a big deal.I got some lessons in assertiveness from the duty Surgical Reg. (Who else...) Its all about language. Our patient is an elderly chap, brought in when his wife found him collapsed, and unresponsive in bed. He had been fine earlier in the evening, but complained of a bit of pain in his hi... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=1028272 Tue, 13 Nov 2007 21:43:00 +0100 1028272 http://www.medworm.com/index.php?rid=1018427&cid=t_119628_85_f&fid=36194&url=http%3A%2F%2Ftesstermulo.com%2F2007%2F11%2F10%2Fnew-recruitment-strategies-by-companies%2F Yesterday, I was at the clinic with a patient when I received a phone call. The guy (who’s using a smart cellphone number) who called asked if I’d be interested to join in their company’s expansion program as a health consultant. I didn’t answer to that and asked him how he got my number and if somebody referred me to him. He said he got it from some “headhunter” that he couldn’t even recall the name (oh great, you’re trying to recruit someone and you don’t even want to remember people who referred that person to you. What about character references? Does he know about that?). I asked him what company he’s working for. Then he answered me by saying words vaguely and were almost gibberish by the sound of it (he doesn’t even h... Prudence and Madness blogs http://www.medworm.com/rss/comments.php?id=1018427 Sat, 10 Nov 2007 11:18:07 +0100 1018427 http://www.medworm.com/index.php?rid=867471&cid=t_119628_151_f&fid=35793&url=http%3A%2F%2Fwww.thejunkyswife.com%2F2007%2F09%2Fless-than-nurturing.html "The 12 Steps : A Way Out is a personal guide to understanding the spiritual power of the Twelve Steps. This material is primarily for adults whose childhoods were negatively affected by a less-than-nurturing environment. This environment often resulted when the adults responsible for care were influenced by substance abuse, emotional problems, or compulsive behaviors. The Twelve Steps offer a way to grow beyond the harmful effects of a troubled environment."I got my book today for the 12 step writing workshop my Nar-Anon group is beginning. I've been excited about it, and I read and finished the first chapter today. Perhaps it's the annoying head space I'm in, but it really made me kind of crazy, especially those few lines above. It made me think that this book is going to push me to delv... Heroin Addiction Codependence blogs http://www.medworm.com/rss/comments.php?id=867471 Thu, 13 Sep 2007 00:49:00 +0100 867471 http://www.medworm.com/index.php?rid=836908&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F09%2Fbringin-it-all-back-home.html I think it's smells, for me.Everyone has a thing that makes them squirm. Maybe more than one. At work, it's smells. Hospitals have a smell all of their own, and each department smells slightly different. I think I found the Burns Unit the most unsettling - because it has ripe smells, but is warm and humid. The whole effect was... unusual.A patient came to us the other day, alive, wishing they weren't. In too many pieces.Three, since you were wondering.It wasn't what they wanted, I guess. I think they wanted to die. Not this. We had to hide them.The legs, in bags. The stumps, under a sheet. Enforced denial. Information control.But it smelled like being in the local butchers, when I was a kid. I couldn't stop the images of a bloody floor, caked in sawdust. Raw meat smells like raw meat, whoe... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=836908 Sat, 01 Sep 2007 09:34:00 +0100 836908 http://www.medworm.com/index.php?rid=801478&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F08%2Ftuesdays-gone.html A little light relief?I thought this was funny, but realise it's non-PC, and I'm kinda the wrong gender to comment. Make of it what you will.First case of the day, an elderly fella, collapsed at the swimming pool. Arrest twice, RoSC twice. Arrived flat, with a suspicious ECG. Great flurries of activity. In the midst of this, one of the Cardiology magicians came down to echo the fella for us, and pronounce on whether a trip to the cath lab would be good for him.My boss was directing affairs, and didn't know this (female) doctor. To remedy this situation he asked her: "Sorry, what's your name, sweetie?"Time froze, and the temperature dropped to absolute zero. Just for a second.Then: "It's Susan, NOT 'sweetie'"'Wang': Normal activity resumed. My boss, for what it's worth calls us all 'sweet... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=801478 Wed, 15 Aug 2007 13:06:00 +0100 801478 http://www.medworm.com/index.php?rid=676972&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F06%2Fi-wish-that-for-just-one-time-you-could.html Again, long time no jib...Sorry. If any of my dwindling readership are still trying, I'm sorry.I've been a little distracted of late. Shroom's fallow period has ended.I have a new object of my affection. And it is mutual! I'm not a stalker. My current squeeze, my babyluv may feature here more later, but not for now. I don't want to jinx it, and I'm not sure I have the right to publish her the way I do myself; yet...Anyway; I have a few local interest 'pieces' to blog about, but they will follow. They're mostly me grumping about what's happening at work. What follows, since we were talking of stalkers (sort of) is the tale of Shroom's only stalker - to date.I know I've alluded to this recently, but don't think I've covered the details.The whole sordid affair took place years ago, when I was... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=676972 Sat, 16 Jun 2007 00:47:00 +0100 676972 http://www.medworm.com/index.php?rid=623466&cid=t_119628_87_f&fid=34865&url=http%3A%2F%2Fwww.thecancerblog.com%2F2007%2F05%2F20%2Fford-unveils-2008-breast-cancer-mustang%2F Filed under: Breast Cancer, Pink products, Fundraisers, Daily newsFord has officially unveiled its 2008 Warriors in Pink Mustang. Available in three colors -- black, metallic silver, and performance white -- this breast cancer-inspired car features a pink ribbon and Pony fender badge, pink striping on the rocker panel, and pink stitching on its charcoal leather seats, steering wheel, and floor mats. Only 2,500 of these Mustangs will be built, and the car will be available in the V6 coupe and convertible models.Ford has given more than $90 million in cash and donations to Susan G. Komen for the Cure over the past 13 years. This Mustang is their latest philanthropic endeavor, and they expect to generate $500,000 in funds for this organization.Ford says winning the race against breast cancer ... The Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=623466 Sun, 20 May 2007 04:00:00 +0100 623466 http://www.medworm.com/index.php?rid=624479&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F04%2Fyou-cant-always-get-what-you-want.html Thus spake the philosopher Jagger.Musing over my previous post, I am reminded of something that occurred when I was a HouseSurgeon at another DGH. The details are less well known to me, as I was just ScutBoy, but it illustrates the same principles well. I'm beginning to think that foremost among them should be "don't believe what you're told", no matter who tells you.In this case, a patient was brought to the A&E (as was) having been 'found down' on a railway track. There was no suggestion that he'd been hit by a train - i.e. he was in one piece - but he was under a bridge. My understanding is that he was first assessed by a rapid response team. Two basic options present themselves:One - he has jumped / fallen from the bridge above. Classification: trauma. Plan: rapid transfer, eager docto... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=624479 Sun, 22 Apr 2007 11:30:00 +0100 624479 http://www.medworm.com/index.php?rid=624486&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F04%2Froom-full-of-mirrors.html Nights again.I still quite like them... tiring as they can be, I can't help but romanticise them a little. No actual romance, mind. A lot of limb injuries for some reason.Fractured arms, wrists, shoulders and ankles. Lots of sedation, manipulation and plaster. Almost a good night at a special interest club.One poor old soul has been given a grim diagnosis; one that we all knew was coming. One of those. An horrendous looking mediastinal tumour, with invasion around his spinal cord. I'm not sure what the exact diagnosis is, but it's clearly not going to be champagne and strawberries. As I've posted before, this sort of thing really takes the wind out of everybody's sails. I always wonder if we could have done more for these guys. Intellectually, I know this is slightly ridiculous, as they ha... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=624486 Wed, 18 Apr 2007 03:09:00 +0100 624486 http://www.medworm.com/index.php?rid=624489&cid=t_119628_88_f&fid=35612&url=http%3A%2F%2Ftheknifeman.blogspot.com%2F2007%2F03%2Funder-pressure_7918.html Some days, I feel like buckling...More on this in a bit; I'm not really in the mood for navel gazing. I'm in the mood to vent. I often get to work early. It gives me a chance to have a coffee, catch up on e-mails and generally ease myself into the day.It also makes one a target for people who say things like "As you're here, would you just..."Of course, the argument runs, if you don't want to be asked questions, hide. (Or don't go in early..?) Either way, I accept this is going to happen, especially in this business. But I reserve the right to say that I'm not on duty. If the fuckers are going to treat me like shit, they can't expect 110% from me. Which I know isn't very caring, but there you go. We're not talking about life and death shit here.So, there seem to be two ways a person might ... The KnifeMan blogs http://www.medworm.com/rss/comments.php?id=624489 Tue, 13 Mar 2007 19:38:00 +0100 624489