Tuesday, 9 December 2008

Opt-In or Opt-Out?

Went to an excellent debate today on organ donation, specifically the current debate on whether citizens of the UK should have to choose NOT TO donate their organs following death (Opt-Out) rather than the current system where we choose TO donate our organs (Opt-In).  Representing those against any change was Earl Howe, conservative spokesperson on health and an Intensive Care doctor from Addenbrooke's Hospital in Oxford.  The other side was represented by Dr Evan Davies, Liberal Democrat MP and Veronica English, vice-chairwoman of the BMA Ethics Committee.

There are about 8000 people waiting for a transplant, with about 2300 transplants carried out each year and something like 1000 patients die each year waiting for a new organ.  The UK is waaaaaaaay down the list in terms of donor numbers with ~13 per million population, compared with Italy (21 pmp), France (22 pmp) and Spain (35 pmp).  When a patient dies 40% of patient's families will refuse, but survey's have shown that if the choice is actually put in front of a person an enormous majority (90% I think) would to sign up to the Organ Donor Register.

So, with Opt-Out, you presume consent.  You assume that if the patient were alive and able to give his or her consent, they would choose to allow their organs to be used for transplant.  Is that something you can presume?  Do we, does anyone, have an assumed 'right' to someone's organs?  Would you like to have an organ from a person when you couldn't be sure that the donor wanted their organs to be used?  With there being so many people dying before an organ can be found do we have the luxury of being apathetic to the need to donate organ?

There are so many more questions and I have a lot of opinions, but do you? Have you thought about organ donation?

Wednesday, 3 December 2008

The View from the Other Side

Well, here they are:

my irritating little buggers of wisdom teeth.  In my first year I spent two weeks with an oral surgery department and saw several patients have their wisdom teeth out under general anaesthetic.  This week it was my turn.  What a weird experience to be on the other side, to be the one led into theatre and asked to lie down on the table.  "Sharp scratch" is what I've heard them say a thousand times when they put the cannula in...not so bad really, "This might feel painful as it goes in" is what they say when they inject the propofol (the white coloured anaesthetic)...and it really does hurt.

Anyway, I'm left doped up on painkillers and getting bored with episodes of ER.  I'd kill to be able to eat Big Mac.

Tuesday, 18 November 2008

Funny Career

So, I was thinking, as I inserted my finger into the rectum of a 60yr old gentleman, that this is a strange career choice.

Then, today I walked onto a surgical ward. I had to go past three police officers, then as I went onto the ward there were two more, each with biiiiiig machine guns...exactly like this:

Why? Because there are two guys on the ward who were stabbed and there's a concern that the guys who didn't kill them the first time are going to come back and try again.  This is all while I'm stood about half a metre from one of the guys.  Some guy comes on the ward shooting I'm worried he's not that good a shot...

1/3 of healthcare staff are abused at work, 1/10 are physically assaulted and there's a good chance at some point I'm going to seriously harm a patient in the future...

Funny career.

Thursday, 30 October 2008

Was watching some endoscopy today, basically cameras inserted into a patient's mouth or bottom.  During which they sometimes use a local anaesthetic spray.  The drug company states that it should taste like bananas.  The Consultant says "Try it" and puts some on the back of my hand to taste a little.

Couldn't feel the end of my tongue or lips for half an hour.

Sunday, 26 October 2008

Fact Me 'till I Fart 1

So, three little facts about your life, you have at one time:

- Been called a blastocyst
- Drank a LOT of your own urine
- Had both male and female genitalia

Saturday, 18 October 2008

Patients are COOL

I LOVE patients.  There are moody ones, boring ones, sometimes really nasty and mean ones but mostly they are lovely, kind and...well...patient.  

I met a lovely young lady this week.  I had to take a full history and then present my findings back to the Consultant.  As a result I had to take some blood for cultures (testing for bacteria) and the way I had to take it meant it was painful and I messed up a little and there was blood dripping down her arm on to the chair!  In fact, I had to get someone else to do it in the end...But, after recovering, funnily enough, she was very thankful and when I saw her the next day as she was going home she had a big smile and said thanks!

What's more, the older they get, the better.  The amount of times I've heard an older patient say "You've just got to make do haven't you?" or "It's not so bad is it really?"  or something like it in the face of illness, always with a cheeky grin, you'd have thought that getting ill wasn't so terrible!  They've got such a great attitude to life, is it just their generation or will we be like that when we're older?

Anywho, many Doctor has said that the only reason they enjoy working in the NHS is the patients and I can see why.

Sunday, 12 October 2008

An Old Man

Just met an old man who is 80.  Has had tongue cancer, throat cancer and now it’s spread to his bones which means it terminal, he won’t live that much longer.   I was taking a history from him, about his illness and treatment.  I got that but I also got an entire life history, ask any medical student, you can’t talk to an 80 year without getting an entire account of that person’s life.

I asked him at one stage “So, how do you feel?”  To my surprise he started crying, he said he was sad, that he was scared and that he didn’t want to leave his family.  First of all, why was I surprised?  Of course it’s sad, of course you’d be scared!

It made me think about all those speeches we've heard, at funerals or something like that, about how we should live life to the full and how we should treat each day as if it’s our last.  We’ve all heard it so many times, I’m sure, that it's become cliché, to the point where we almost ignore it.

Do any of us really live like that, or even try to?  Do we care that much about doing so?  It seemed to me that this guy was upset because he rather enjoyed living and thought he’d had a good life, so much so that he was sad to leave it.  We should all be so lucky.

Monday, 6 October 2008

A Lovely Reminder...

Well, I heard a story this week about a woman who got cervical cancer and had to have here womb and ovaries removed so I thought I'd remind any women watching to get a Pap smear! Yay! Woo Hoo, cervical smear are exciting! You should all get one!

They aren't that exciting...I know, I know, they aren't pleasant...in fact...pretty unpleasant.  But since cervical cancer accounts for 5% of cancers worldwide...get it done!  And any blokes reading...pester.  Remember it'll be a practice nurse who does and they do MILLIONS.

Factoid - "Pap" is shortened from Human Papilloma Virus (HPV).  HPV is the cause of cervical cancer, found in like 99.5% of cases.  Certain strains (16, 18, 31, 32) are oncogenic...ie the cause cancer.  HPV also causes warts...super.

Thursday, 2 October 2008


Well, that was mental.

I found myself volunteering to observe a post mortem examination on two paediatric cases the other day.  So I turned up at 9 O’clock at the Pathology Block, walked in with five friends, put on white coats then stepped into the PM room.  It was a pretty un-remarkable place, three tables for the examinations and the freezers at the end for storing the bodies, in the corner was a small pile of bags and then an observation room.

The first shock was that the small bags in the corner actually contained the bodies which were being examined that day.  They were very small, that’s what I remembered, they were very small.  Without even a second to breathe the Pathologist brought out, from one of the bags, the first body, of a 27 week foetus.

Everyone knows what a baby looks like, and so, in a way, knows what to expect a dead baby to look like.  A foetus is a wholly different thing, remember that a foetus should be in the womb for around 40 weeks so a 27 week foetus still has some developing to do and looks, in all honesty, quite scary.  I don’t really want to describe what happened but basically I found myself very dizzy, close to fainting and needing to sit down.  My friends told me later that I had gone completely white, even my lips were white.  All the blood had drained from my face into my feet.  The second case was a ten month old baby, most likely a case of ‘Cot Death’, technically called Sudden Infant Death Syndrome (SIDS).  It looked just like a cute, cuddle baby boy should.  It was very hard to think of it as not living, well, it shouldn’t be easy really…should it.

So here are two stories, two of many, where a young child has lost its life and set of parents have been tragically denied the chance to bring it up and care for it.  There’s no crime here, neither baby was killed by intent or negligence, it’s just that life, sometimes, is a shit and bad stuff does happen.  Not just “I lost my iPod” or “I’ve just been fired/dumped/mugged” bad, but painfully, sorrowfully bad.

How on earth can one grasp what has happened to these children?  These two lives never had the chance to see the world, enjoy it, enjoy relationships with other people as I have. Also, how many people realise just how complicated life, and the creation of life, is?

I remember Prof Robert Winston saying that if 100 000 couple had sex tonight, without protection and at a time in the month when the women was fertile there would only be likely 40 000 births.  40% of pregnancies don’t last beyond 12 weeks.  Life is so fragile, we need to treat it with way more respect that we do, like a precious gift that has been entrusted only to each one of us.

I would hope we all take a little moment to think about that.

Every Student Does It

Every student, when they first try to do something clinical will make a prat of themselves.   This week it was my turn.

I was with an anaesthetist and she asked me to go and inject a drug into the patient’s bag of saline solution.  So I walked over to the drip and got the syringe with the big sharp needle attached, aimed for the hole where you inject the drug and advanced the needle.

It took me a second to realise why the needle hadn’t gone into the bag, it had gone into my finger.  After a quiet “Ow!” and an admission of failure the anaesthetist came over.  In order to save me a little dignity she quietly suggested that I injected the drug via a small 3-way tap in the fluid line.  I grabbed the tubing and almost imediately noticed some blood was on it, it was of course my blood from the needlestick injury.  “OK, just go and wash your finger and sit down” said the anaesthetist mid eye-roll. 

Needle 1, Dignity 0.

A Different World

I’d like you to meet Chris (not his real name).  He’s mid twenties, and lives in the East End of London.  Life took a few bad turns, like anyone’s, but the bad turns kept coming and before long, and as is often the case in this part of the world, he ended up using drugs.  A little at first but slowly the drug use increased and began spiralling out of control.  He’s now on £80 of heroine, £80 of cocaine and 2 litres of cider a day.  He can’t get any work and his benefits don’t cover the drug use, so of course, he has to steal to fund the habit.  He lives in a flat and it would be alright but the lock has broken and without money to fix it people have got in and stolen everything he has, including his boiler, some one has even taken time to spray ‘Crack House’ over the door.

Chris’s story was one I heard about during a clinical meeting at the Specialist Addiction Unit in London’s East End.  The SAU is there to help people with serious substance abuse problems which are too tricky and complicated for GP’s and community drug teams.  There are a hundred and one stories like Chris’s and a lot of them are a lot worse, I could tell you some crazy, heart breaking stories.

We talk a lot about the broken and the dispossessed in Church, and quite rightly because Jesus did, but I am realising that I’ve spent a lot of my life treating them as an abstract group of people.  My medical school is situated right in heart of the poorest boroughs in the UK and I guess I’m learning just how broken the broken are and how dispossessed the dispossessed are.

I know this will sound ridiculous but sometimes it’s a bit annoying being a middle class, middle England Christian.  As a prime example myself I think I have maybe become a bit sheltered and distanced from the tough lives people have to live.  With an upbringing like this you can never understand what it’s like to live in a world of poverty and without opportunity.  More importantly perhaps, you can never really understand what it takes to ‘fix’ the problems.  I’m not saying that everyone should be forced to live in poverty and isolation in order to understand the plight of some people in society but we, comfortable middle class types, should spend a lot more time learning about it and getting out of the way of those who do know how to help.

Wednesday, 1 October 2008

A Strange Afternoon

"That was fascinating," I said, "Could I observe you this afternoon as well?"

"Of course" replied the Consultant Anaesthetist "We're doing STOP's"

"What's that?"           



So began the strangest afternoon of my life.  After spending the morning observing reconstructive surgery I was going to observe, indeed assist, the Anaesthetist during Surgical Termination of Pregnancy, or STOP, procedures.


So I spent four hours holding open these women's airways and doing their breathing for them, one hand holding the mask to their face and the other one squeezing the air bag...squeeze...1, 2, 3...squeeze...meanwhile the consultant in family planning gowned up and proceeded with the abortion...squeeze...1, 2, 3...squeeze...then, 4 minutes later the patient was rolled on to her side and wheeled down to the recovery room. Done.


There were seven women due for terminations that afternoon.  Some were nonchalant, some were quiet and a couple were clearly upset.  The last woman came in and was quietly crying, and as I held her head as she went under the general anaesthetic I sent a quick prayer up, it seemed all that I could do.


There are stories in the media of doctors who have been attacked because they perform abortions, invariably by right wing Christian groups, but when my day comes and I stand up on the day of judgment I will proudly say that I was there with those women helping in the only two ways I could:  Holding their airways open and asking the only person whose opinion counts to be with them.


If you want a sure fire way to get Christians fired up then all you have to do is mention one of two words: Homosexuality and Abortion.  I don't know what your opinion is on the issue of abortion - is it killing one of God's children or is it the absolute right of a woman to be able to determine what happens to her body? - and to be honest I don't really care.  When you’re standing right next to one of these women it couldn’t really matter less.

The Intro

Thought my first post should be a little intro about me so that people know where I'm coming from...

I've just started my third year at a Medical School in London,  and my posts will be made up of stories from the wards and GP's surgeries that I visit and spend time at.  Hopefully they'll provide some funny stories, maybe informative and, even better, provoke some discussion!

I hope you enjoy it!