A Day on a Hospital Trolley

Even though he’s a fictional character, GP Geoff is not so very different from most other medics. If he needs to see a doctor, all he does is look in the mirror.

hospital entrance

But the swelling and dragging sensation in his left groin have become hard to ignore, and today he’s going into the Day Surgery Unit of his local hospital. Hernia repair used to mean a sizeable incision and several days in hospital, but, with keyhole surgery, Geoff will be home the same day.

About 90% of operations are now done as day case surgery. Beds are as rare as unicorns, thinks Geoff as he meets Cecil, the day care nurse who’s looking after him today.

Today Geoff doesn’t get a bed, just a trolley on a six-bedded ward. If a patient turns out not to be fit to go home the same day after all, then he gets to stay overnight. On that same trolley.

Geoff has been qualified just 15 years and already things have changed beyond measure. Or have they always been like this for patients?

surgical dressings

A junior surgeon pops round with a consent form, then the anaesthetist visits. Geoff is distracted by her dazzling smile, her shock of red curls, but mostly by her multiple nasal piercings. What happens when she has a cold?

“With modern anaesthetic drugs,” she tells him, “you wake up so clear-headed that you can do The Times crossword.”

Which is wonderful because Geoff’s never been able to do The Times crossword.

He won’t get a pre-med, which is a shame. It used to be the best thing about having surgery, but there’s no scope for such things on the day surgery conveyor belt. Besides, Geoff needs to be in charge of his feet, because, when he’s changed into a flimsy gown and paper underpants, a nurse takes him for a long trek to the operating theatre. He hopes he doesn’t run into any of his patients.

Geoff meets the consultant surgeon for the first time in the anaesthetic room. He’s more Doogie Howser than Dr Finlay. Geoff resists asking if his mother knows where he is.

scalpel

When it’s all over, he can hardly feel he’s had anything done, but he’s lying in a large well-lit room where a nurse is telling him to drink. He had not realised he was clutching a small Styrofoam cup.

Back on the Day Surgery Unit, Nurse Cecil checks his pulse, blood pressure, and oxygen saturations every half hour, and reminds him to eat and drink. There’s an obligatory six hours before he can go home. There’s also the requirement to consume the tea and roast beef sandwich placed next to him.

The man on the neighbouring trolley is smiling at a film on his iPhone. Geoff can’t see the man opposite, as his girlfriend is busy delivering a prolonged post-op snog.

Geoff decides against powering up his phone. The pre-op instructions were clear: do not do anything important in the next 24 hours. The last thing he needs is a spirited twitter exchange with one of those anti-vaccine types.

Geoff doesn’t have a newspaper so he can’t test the anaesthetist’s promise. He brought the latest British Medical Journal, but he doesn’t much feel like it now. Or the sandwich. 

British Medical Journal

The patient by the window has already regained his appetite, judging by the takeaway his family brought in. The red and white packaging is already open, filling the ward with the heady aroma of grease, along with 17 different herbs and spices.

Eventually Geoff does what’s required of him: drink, eat, and pass urine. Post-op pain is breaking through by the time he gets to the tiny WC, where someone has already hosed down the floor.

In the corridor, one of the female patients is asking Cecil where she can find a nurse, oblivious of the fact that she is speaking to a nurse. “I’m a nurse,” says the nurse. The patient’s face is blank.

Finally Geoff goes home with a paper bag. It has spare dressings, a packet of painkillers, and instruction leaflets on not picking your scabs.

There’s supposed to be a responsible adult with him for the first 24 hours at home. Geoff, who’s single, fibbed about that bit. Luckily nobody checks, and he absconds in an Uber.

Nothing will go wrong, Geoff tells himself. Aside from the little lie he told the hospital, he plans to be a good patient and take careful note of all the instructions. At first, he is a little confused by the stated telephone times.

Then he realises it’s exactly like Sainsbury’s, trolleys and all.

 

Geoff lives in North London where he looks after patients, longs for a meaningful relationship, and rants about the NHS. You can find out more about him and his life in the pages of Hampstead Fever.

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When Beer is an Aid to Diagnosis

With the FA Cup semi-final, pubs attract their fair share of crowds. Today I spotted a Spurs supporter with deposits of cholesterol around his eyes, along with a physique one can only get from eating all the pies.

This spot diagnosis took me back decades to my days as a medical student at the Middlesex Hospital, when we’d try to convince ourselves that time spent in a local hostelry was equivalent to the same amount of time spent poring over textbooks.  

Three essential texts

I say ‘we’ but the pub pathology sessions were a guy thing. There were just four women in my year. Swots that we were, however, we often tagged along to make sure we didn’t miss out on anything educational.

We didn’t just think of the pub as a causal factor in disease, though it must have been in some cases. One of doctors would regularly claim that the King & Queen had given him spider naevi (small blood vessel swellings typical of liver disease).

In the interests of presenting both sides of the story, I’d like to add that Steve from my year was convinced that impurities in the beer were to blame for all the complications of excess alcohol.

“Pints of Beer” by Simon Cocks is licensed under CC BY 2.0

Anyway, someone would go, “That’s a basal cell cancer over there.”

“Where?”

“Guy at the bar. Left cheek. Don’t stare.”

“So it is.”

“Also known as rodent ulcer,” another student might offer.

“Doesn’t spread to distant organs,” said someone else at the table. “Not ever.”

“Unlike squamous cell carcinoma,” added a show-off.

“You’d never know I had PSORIASIS – SIROIL 1959” by Nesster is licensed under CC BY 2.0

A pint or two later, one of us claimed to have spotted psoriasis. All nodded sagely, even though at that stage we barely knew the difference between psoriasis, cirrhosis, and sclerosis.

It was like winning the jackpot when a man with a stomping gait entered the pub one winter evening. This type of gait occurs in late syphilis, when foot position sense is lost, so the person bangs the foot down hard at each step. Although it’s possible that the man was just been getting the snow off his boots.

I like to think that the fictional GP Geoff from my novels will have once given pub pathology a whirl. On the whole, however, education has moved on. Sitting in the pub is not a learning method I’d recommend to my current medical students. For one thing, misdiagnosis is common. For another, it’s rude to stare.

Though sometimes it’s impossible not to. In one saloon bar, there was a man with a massive swelling down there.  So ginormous did it grow that he needed a wheeled trolley to help him (and it) get around. He finally did seek expert advice, but, it was said, only when one of the wheels fell off the trolley and needed to be replaced.

One keen student was desperate for the chance to shout, “Let me through – I’m a medical student,” but we never witnessed a medical emergency. Lucky, really, as our life support skills at the time would have done nobody any favours.

We never saw anything as dramatic as the stripper and the snake, though we all heard about it, naturally. This particular lady had a snake as part of her act, until the night her sidekick decided to hug her neck a tad too tightly. She was rushed to A & E wearing little more than a sizeable reptile, where an anaesthetist injected the snake with muscle relaxant and saved her life.

Photo FreeImages.com/Marcel Herber

As I say, we all heard about it. But we missed it. We were in the pub instead.

***

GP Geoff and other characters can be found in my novel Hampstead Fever.

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Hampstead Fever

How to Alienate Your Doctor in 10 Easy Steps

Articles in newspapers and magazines often give advice on how to get the best out of your doctor. The idea is to maximize the benefits of a consultation and to relieve pressure on the NHS at the same time.

National Health Service logo

But where’s the fun in that?

With a little planning, you could properly annoy your doctor instead. Here’s my advice based on decades working in the NHS, together with one or two favourite tips from my fictional GP colleague Geoff, the doctor in Hampstead Fever.

Hewlett Packard Rapaport Sprague stethoscope

I like to think these are steps almost anyone can take.

1 Prepare for your appointment by not showering or washing for two weeks. Don’t wash your clothes or change your underwear either. With clean clothes, you’re just not playing the game.

2 Bring a list. It should include all the symptoms you’ve had in the last five years. Aim for about 20 or so different complaints.

3 if you don’t have enough symptoms of your own, bring the family. A babe in arms, a couple of hyperactive toddlers, and a deaf granny should do the trick.

4 Kick off the consultation with, “This won’t take a minute, doc.” Which is true. It will take an hour.

kitchen-clock

5 To help your doctor’s diagnostic skills, offer a couple of well-chosen newspaper cuttings or internet printouts. You know the kind of story: Vaccines Kill Millions, or New Miracle Cancer Drug. On no account must you allow your GP to dissuade you. After all, Dr Google is so much better than a living breathing doctor with actual qualifications.

6 When the baby’s nappy needs changing, leave the soiled one behind in the doctor’s bin. This ploy is a good one for the summer months.

7 It’s only polite to take your chewing gum out before saying, “Aah.” Leave it in a tidy blob on the GP’s desk.

8 Exhibit your verrucas, ingrown toenails, chilblains, or bunions at every consultation (what do you mean, you don’t have any?). Before you put your sock back on, it’s de rigueur to get it the right way round by shaking it vigorously at your GP.

sock

9 Don’t ask for an antibiotic for your cold. Demand one. You know your rights. If necessary, remind your doctor that you pay his or her wages.

10 Save your best symptom till last, and mention it only when you’re about to leave. Thus, hand on the doorknob, you can say, “While I’m here, doc…”

FreeImages.com/Robert Eiserloh

With a bit of practice, you should be able to piss your doctor off without even trying.

***

For the really perverse who actually want to get the best from their doctor, here’s my advice, along with some wisdom from fellow GP Mark Porter in The Times.

The Post-Truth Era

Everyone’s saying it, so it must be true. We live in a post-truth era, in which unsubstantiated statements are swallowed whole. The less palatable they are, the more easily they slip down.

Post-truth was made word of the year – the Oxford Dictionaries’ International Word of the Year, no less. Post-truth is of course instead of truth, not after it as in, say, post mortem or post-Apocalyptic.

As you see, even the term post-truth is lying through its teeth. But what does it matter?

old-books1

Post-truth got some massive boosts this year with Brexit and the US Presidential Election. While Michael Gove didn’t actually start it, he did famously say that people in this country had “had enough of experts”.

Experts are now superfluous and fact-checkers obsolete. These days momentous decisions are made without anyone bothering with evidence.

That doesn’t just make me worried. It makes me deeply suspicious not just of politicians but of pretty much everything, cute animal videos included. What if I’m not watching an Alsatian licking a kitten clean, but just a cleverly doctored video of a dog preparing his lunch?

posed by model. photo by Roger Heykoop

I can see how we got to post-truth. Everyone has an opinion, and now it has just as much value as anyone else’s. Social media provide an echo chamber where anyone can have their say, as well as share hatred and intolerance.

Twitter wasn’t big in Lao Tzu’s day, but I think he nailed it with “Those who know do not speak. Those who speak do not know.” 

As a doctor, I’ve lived with post-truth beliefs for some time. One patient with appendicitis, who, on being advised surgery was needed, declared that it wasn’t for him. An operation might be our way of doing things, but not his. Thus he belted out of Accident & Emergency into the night. FreeImages.com/Antonio JImenez AlonsoSaddest of all in my view is the mother who, after lengthy discussions, still refused immunizations for her baby. “I’m doing what I think is right,” she told me. “After all, that’s the most important thing.”

The most important thing? God help her child.

It’s clear how we got to the age of unreason, but it’s less clear how we’ll climb out of it. Trump’s inauguration is scheduled for next Friday, and we are where we are.  Though there is a well-known story about a tourist in Ireland. Lost, he asks one of the locals for directions to Balbriggan. The Irishman replies “Well, sor. If I were you, I wouldn’t start from here.”

FreeImages.com/Mira Pavlakovic

 

A Christmas Gift for Syria

For two weeks now, I’ve felt proper sorry for myself, wallowing in a sea of tissues with a voice that’s no more than a croak and a brain that’s as sharp as blancmange. The world can feel like it’s ending when you run out of LemSip, and neither husband nor cat will get near you for the stink of menthol and eucalyptus.

symptomatic relief for a cold

Then I turned on the TV.

After six years of war, the humanitarian situation in Syria is catastrophic. Hospitals and medical staff have been deliberately targeted. It’s a war crime, and it has left hundreds of thousands of civilians without access to medical care, even as the bombs rain down.

There is no children’s hospital left in Eastern Aleppo, and about 250,000 people are estimated to be without medical care.

But that could change by Christmas.

The People’s Convoy is crowdsourcing funds to build an urgently needed new children’s hospital. Dr Rola Hallam, a UK-based doctor (founder of CanDo and previously headed Hand in Hand for Syria), launched the campaign a few days ago. Here’s a piece from Channel 4 News which includes her interview. 

Laden with supplies for the new children’s hospital, the convoy will set off from London on Saturday 17th December for a seven-day overland journey arriving in Turkey. There it will meet the Independent Doctors’ Association (IDA), the Syrian medical/humanitarian organisation that is still operating in Northern Syria. 

incubator

The supplies will then be used to refit an existing building as a new hospital, which will be the first crowdfunded hospital in the world. It’ll be in the countryside north of the city, and will serve 185,000 people.

The convoy is a collaboration of leading medical relief agencies, humanitarian organisations, medical workers’ associations and campaign groups, including Medics Under Fire, the Independent Doctors’ Association, Physicians for Human Rights, Doctors of the World, and the Syrian American Medical Society, as well as Rola Hallam and David Nott, considered one of the world’s most experienced war surgeons. 

While governments fail to resolve the crisis, people can act, and you can help right here: The People’s Convoy.

You can keep up to date with the campaign and the convoy here: CanDo.

doctor examining baby

This is more than a convoy of medical supplies. It’s a convoy of hope, sending a strong message of solidarity and support to courageous Syrian medical and relief workers, telling them that they aren’t forgotten or alone.

It’s also a convoy of defiance: a strong message that humanitarians and human rights’ advocates will not be silenced or stopped from their life-saving work.

Please help spread the word, and give what you can to the People’s Convoy.  

It’ll do far more good than a box of tissues.

FreeImages.com/T. Al Nakib

December 18 update:

If you’ve already donated, thank you very much. The campaign exceeded its target, and the convoy left central London yesterday, as you can see in this piece from today’s Sunday Times.

Rebel with a Cause

Poetry and medicine intersect in Jane Davis’s latest novel, My Counterfeit Self. I’m delighted to welcome Jane back to my blog on publication day.

JDV-MCS2016-Clays-02

The main protagonist is Lucy Forrester, a political poet and activist. Anti-establishment all her life, she’s now horrified to find herself on the New Year’s Honours list. Her inclination is to turn it down. But what if it’s an opportunity…

When researching a cause for her rebel, author Jane Davis followed a thread from the first CND march from Trafalgar Square to Aldermaston, to the plight of Britain’s forgotten Atomic Veterans. Here is what she discovered.

“It is 1958, six years after American scientists disbanded the Atomic Bomb Casualty Commission in Hiroshima, having completed their data-gathering on radiation sickness. It is a supposed time of peace. Imagine you are eighteen years old, shipped to Christmas Island on National Service. It is the furthest you have ever strayed from home.

Your job? To stand on an idyllic white sandy beach and observe as scientists detonate nuclear bombs in the Central Pacific. When the signal is given, you must turn away from the blast and cover your eyes with your hands. There is no protective clothing. As the flash goes off, you can see your veins, your skin tissue, your bones, and through it all, diamond white, a second sun. Searing heat builds inside, until you imagine that there is only one way it can end.

Around 22,000 servicemen were ordered to stand and observe. Some suffered radiation sickness immediately, and some died. For others, symptoms followed patterns seen in Hiroshima. They lost their appetites, ran high fevers, and their hair fell out in clumps. Some appeared well for decades before developing cancers and other rare diseases.

It was only over time, as dots were joined, that some veterans became convinced their illnesses and disabilities were caused by nuclear radiation. Their bid to be recognised by the European Court of Human Rights was denied in 1998, which said it had no jurisdiction in the case. Largely ignored, and dwindling in number, the veterans referred to themselves as ‘ghosts’.

Then, in 1999, researcher Sue Rabbitt Roff at the University of Dundee tracked down and surveyed 2,500 veterans and their children, reporting unusually high rates of infertility and birth defects. This was the trigger. The columnist Richard Stott (1943 – 2007) of the Sunday Mirror then launched his Justice for Nuke Vets campaign.

If I saw this reported in the news, I’m ashamed to say that I have no recollection of it. There were always more attention-grabbing headlines. But when researching my novel, it was obvious to me that this is a cause Lucy Forrester would have thrown herself behind.

The British government continued to insist on more proof. It wasn’t until 2007 that two scientific studies demonstrated clear links. They also estimated that genetic birth defects would last for 20 generations – in other words, 500 years.

As a result, 700 New Zealand and UK veterans launched a class action lawsuit against the British government claiming NZ $36 million in damages. But it had all happened 50 years ago. The Ministry of Defence countered with a statute of limitations defence.

Following a parliamentary inquiry in early 2008, the government agreed to fund new studies into veterans’ health, and to pay interim compensation of £4,000 each.

By the time I completed my research, the government had set aside £25million (£5million a year over five years) for an Aged Veterans’ Fund. But this wasn’t only for the surviving Atomic Veterans. Approximately two million veterans were qualified to apply. In addition to applications from individuals, the British Veterans’ Association (BNTVA), the premier charity representing those who have worked alongside radioactive material for the benefit of the nation, can apply for funding for projects such as respite care or counselling. Whilst any such services may benefit the families of the Atomic Veterans, once the remaining veterans die, all funding will cease. Without an admission of negligence from the MoD, there will be no help for the 20 generations.

Many Atomic Veterans are proud to have served their country. However, given that the risks of exposure to radiation were either known or reasonably foreseeable, they had every right to expect their government to take care of them if things went wrong. They couldn’t have imagined that the British government would introduce a higher burden of proof than other governments, so that their American counterparts received compensation while they did not. It should not be left to the Prime Minister of Fiji to step in and award each surviving veteran three thousand pounds, saying, ‘Fiji is not prepared to wait for Britain to do the right thing’.

With Trident firmly back in the headlines, I hope that it will rise to the surface once more.”

You can find out more about the Atomic Veterans or make a donation here

jane-facebook-profile

Jane Davis is the author of seven novels. Her debut, Half-truths and White Lies, won the Daily Mail First Novel Award, and The Bookseller featured her in their ‘One to Watch’ section. Six further novels have earned her a loyal fan base and wide-spread praise. Her 2016 novel, An Unknown Woman, won Writing Magazine’s Self-Published Book of the Year Award. Compulsion Reads describe her as ‘a phenomenal writer whose ability to create well-rounded characters that are easy to relate to feels effortless.’ Her favourite description of fiction is ‘made-up truth’.

When Jane is not writing, you may spot her disappearing up the side of a mountain with a camera in hand.

You can also find Jane Davis on Facebook, on Twitter, on Google Plus, on Pinterest, and on Goodreads, as well as on her Amazon author page

Anyone who signs up to Jane’s newsletter receives a free copy of her novel, I Stopped Time. Jane promises not to bombard subscribers with junk. She only issues a newsletter when she has something genuinely newsworthy to report.

My Counterfeit Self is published October 1, 2016, and available in paperback and ebook formats.

jd-red-tbw

 

 

What You Can Do for London’s Lungs

Take a nice deep breath. For thousands of people living in London, that’s a luxury.  

FreeImages.com/Christina Papadopoullo

With its plethora of parks, our capital may be one of the greenest cities. But it’s also one of the most polluted. For the last five years, London has been in breach of EU safety limits on NO2.

I’ve noticed it getting worse. For an instant lesson in air quality, head for the outer reaches of one of the Tube lines and see how fresh the air feels when you step outside. 

Pollution isn’t just an irritant to the throat, nose, or eyes. It’s damaging to health, increasing the risk of lung cancer and chronic lung disease, and driving up hospital admission rates for those with pre-existing lung or heart disease.

FreeImages.com/Dave Kennard

Children’s lungs are most vulnerable, yet around 330,000 London kids go to school in areas with illegal levels of pollution.

Pollution has also been linked with damage during pregnancy, including low birth weight and pre-term birth.

I’ll cut a long story short: at least 9,500 deaths a year in London are linked with air pollution.

We may not have the pea-soupers of the 1950s that smothered London in soot and sulphur dioxide for days at a time. But we have a haze of small particles, especially PM2.5s, along with the toxic gas nitrogen dioxide NO(not to be confused with laughing gas because this one isn’t funny).

FreeImages.com/Simon Gray

PM2.5s are fine particles, less than 2.5 micrometres in diameter. They come from things like motor vehicles, power plants, and wood-burning, and they’re harmful because they’re small enough to reach the deepest recesses of the lungs.

Nitrous oxide comes largely from diesel cars, lorries, and buses. It follows that pollution is worse near busy roads, which is often where less advantaged families live. But even short-term exposure to air pollution can damage.

Why am I banging on about it now?

Because on May 5, London elects a new Mayor. As a parent, a doctor, and a Londoner, I whole-heartedly support The British Lung Foundation’s #Londonlungs campaign. It calls for the next Mayor and Assembly members to prioritise lung health.

FreeImages.com/Andrew Rigby

So much could be done, from tree and hedge planting schemes to improving transport strategy and extending the ultra-low emission zone (ULEZ) eastwards – where there’s a lot of deprivation and air pollution.

You too can help by getting on board and asking all the mayoral candidates whether they pledge to protect Londoner’s lungs. You could also share the campaign on social media with the hashtag #Londonlungs.

FreeImages.com/Adam Ciesielski

What else can you do?

There are obvious individual steps to help protect the lungs and heart, like not smoking.

Driving less, for instance by sharing cars or using public transport, helps drive down vehicle emissions. If you’re buying or leasing a car, choose a low-emission model.

Take the longer route on foot or cycle via a less polluted area if you can. You may be interested in the Clean Space app

The British Lung Foundation has some great tips for when air pollution levels are very high. You can find them here