Monday, February 26, 2007

"Nonsense on stilts"

Apologies to regular readers. It may appear I have been off on one of my now legendary Woganesque holidays. Sadly nothing could be farther from the truth. If fact this little corner of Borsetshire has been a tad busy of late. And on top of that I am again helping to mould the mind of one of the generation of medics that are to come after me. (Well, hosting a final Year Med Student for a couple of weeks out in the real world anyhow.)

And yes, lately that real world has been a touch too real for my taste. Thing is, Clive Horrobin walks abroad. If you are thinking that is the sort of sentence that should only be uttered to the accompaniment of arch glances toward the door or window of the consulting room, and preferably a few ominous chords from the brass section, then you’d be right.

Poor Clive doesn’t really fit in. This gets him frustrated, and in turn the frustration makes him angry. When he gets angry he makes threats. Nasty, personal, “I’m gonna come round your house and kill all your pets” sort of threats. He does this to anyone who frustrates any of his natural desires, like the impulse to take lots and lots of stimulants, mind altering drugs, both illicit (a little coke to go with his “Coke”TM), and licit, (Booze, Major and Minor tranquilizers, antidepressants and monster dose hypnotics).

Because he has been frustrated in his desire for these basic commodities of everyday living he has threatened a few medics, rather more receptionists and a whole bunch of other quiet and law abiding citizens. In our brave new zero-tolerant world Clive is a “Violent Patient” a cachet his is happy to wear like a teen with a hoody and an ASBO. It makes him "Special".

So special we have to seem him in a secure room at the hospital, with uniformed security personnel standing by.

This last week it was my turn to play “Clarice Starling” and go see “Hannibal” in the maximum security wing that is the local A&E* broom cupboard. It got rather crowded what with Clive in his Hockey Mask and Pallet Trolley rig, two burly Boys in Blue, and yours truly cowering somewhere to the rear and close to the emergency exit.

And the reason for this little edifying Tableau Vivant?

Clive wanted to tear me off a strip and threaten to kill my cats because we hadn’t given him the four-times-normal dose of sleeping pills he needed to help him come down off his speed and coke and “Coke”TM. In doing this we are breaching his Human Rights. I endeavoured to point out from my commanding position at the back, that he had done a fair bit of Human Rights infringing of his own, having threatened to duff up several nurses, porters, hospital docs and a couple of my esteemed partners in the past week or so, but it cut no ice. “See I don’t care about them, it’s my rights I care about innit!” he reasoned. An argument I imagine he is not used to having challenged much.

Sadly for Clive it didn’t work this time for I am made of sterner stuff, at least from behind a phalanx of blue serge I am. Oh, and the cats are off to the cattery this week, for later on I am indeed awa’ for a long weekend north of the border.

And the timing of this little trip is of course entirely coincidental.

* American readers would know this as the ER Closet I imagine**.

**They would also need to subtract the mental image of guards with Marine Corps crewcuts and belts weighed down with Nightsticks, Mace and Firearms. That's just not the way we do things in dear old Blighty. Yet***.

***We get "Kev" and "Baz" in blue pullys, scratchy trousers and peaked caps. And I am eternally greatful to them both.

Thursday, February 15, 2007

Suffer the children

I have a box of Lego in the corner of my consulting room. Kids from age three to eight can’t resist tipping it all out all over the floor and engaging in some serious construction whenever they can. The little girls build great long walls of neatly aligned bricks or soaring towers one brick wide. The boys, almost without exception, build great big guns and stomp about the room going “dakka dakka dakka” or making similar martial noises.

(When the last Star Wars movie was on they did, briefly, nick the towers off the girls and use them as Light Sabres instead, but only briefly, then we were back to the guns.)

So why mention this now.

Well this week sees the third shooting of a teenager in London in 10 days. Two of the victims were just 15 and both were shot in their own homes (one whilst still apparently asleep in bed). The implication in all the current news coverage is that the shootings have been carried out by a person or persons of a similar age, and that this has something to do with gang culture. I’m not sure what evidence they have for this, but for Blighty three seemingly gang style assassinations in so short a time is unusual, and with such young victims, is, so far as I am aware, unprecedented.

Boys have an enduring fascination with guns. This has been the case, I suspect, ever since the first evolutions of black powder ballistics. That fascination carries forward into so much of our popular entertainment from Kelly’s Heroes to Private Ryan, The Magnificent Seven to James Bond, pretty much anything by Jerry Bruckheimer… the list goes on and on.

Furthermore it appears Britons are the worst parents in the developed world and their teens are the drunkest, most doped up, most promiscuous teens anywhere. (Or so say the OECD and the WHO). With such apparent lack of parental control why wouldn't they also gan up to commit mayhem?

When we witnessed the collapse of the Cold War and the wholesale demolition of the Iron Curtain we lost a shared “enemy” and gained an unrestricted market for firearms, and now those same firearms are so available and so cheap they are finding their way into the hands of kids little older that the miscreants making WMDs from the Lego in the corner of my room.

No teenager of my experience, not even the most heavily eye-linered Goth-boy, has any true concept of mortality. At that age we all feel immortal, as indeed we ought. PCs, Playstations, and the plethora of other consoles and platforms teach them that if you hit the right sequence of squares, triangles and circles your on screen persona becomes impervious to all harm.

As a lad of fourteen I spent many a cheery afternoon at the range firing my twenty rounds from a trusty old Lee-Enfield as a cadet at school. I got to see first hand and up close what a bullet could do to a half inch thick sheet of plywood, and it didn’t take much imagination to work out what it might do to squishy stuff instead. You can’t get that from a console. Without that experience it’s easy to see how gun “play” turns in to “Gun-play”.

Right now I’m beginning to wonder if it’s time to lock the Lego away.

Tuesday, February 13, 2007

Guess which Dwarf I'm being today.

It's no good. I'm having to come to terms with an uncomfortable truth. Over the past week or so it has been increasingly apparent that I am now officially a grumpy old man. If I'm honest the signs have been there for some months now. The irritable shouting at the radio in the mornings, especially, as it happens, when the secretary of state for health is on, the mumbled commentary to the evening news, the irrascible scrabbling for the mute button when that bloody irritating lloyds TSB ad with the wrethched squeaky singing comes on. You know, little things like that.

Last night I hit a new low when I found myself agreeing with the wise words of David Milliband. Lets face it, he's a politician, in opposition, so of course he's going to say that Health Services ought to be run by Health Professionals and not Politicians. After all, isn't that what Tone and his cronies were saying eleven or so years back. And there was me in the car on the ride home nodding like the Churchill Dog as Mr M intoned his pearls of wisdom to whichever interviewer it was putting him to the question. What was I thinking?

Then today, en route to Tesco Express for a quick sarnie after the lunch-time visits, what should I espy but a bunch of thirteen year old herberts larking about in the car park. Why aren't the little blighters in school I thought, completely ignoring the fact that our own offspring are off with rel's for the Half Term holiday. D'oh!

Last week some diminutive pink, bobble hatted pixie snowballed me as I was coming out of another home visit, and it was all I could do to prevent myself from upending the offending moppet into a nearby snowdrift in retribution. Then there was the traffic on the way home last Friday. Honestly. Three measly inches of the wettest, saddest snow ever, and gridlock ensued. Three bleeping hours to do a forty minute journey I ask you!!!

Look!!! Now I'm even doing multiple exclamation marks, and I HATE multiple exclamation marks !!!!

But the thing that really brought home to me just how grumpy and down right grown up I've suddenly become was the reaction to that first snowfall last Thursday morning. Instead of the unrestrained glee of the junior members of the household, or even the wistful "winter wonderlandishness" of my better half, all I could muster was a miserale moan about the state of the roads.

Bah, Humbug!

Tuesday, February 06, 2007

Call me Dr Killjoy.

In walks Minerva Bannister, her eighty year old frame propped up by a wheely-zimmer-stool thingy of impressively modern design, which she promptly reverses into place, applies the brakes and perches upon. She’s been summoned to the chest clinic and demands to know why. At least she does when she’s stopped gasping and spluttering after her shuffle down the corridor.

As she sits there it occurs to me, looking at her assorted list of ailments, that it is her atheroma hardened arteries that are holding her up more than her porous bones. Her leathery hide, wrinkled as any elephant, is tattooed with the accumulation of sixty seven years of nicotine exposure. She looks for all the world like a Neolithic peat-bog mummy. Just one with a bit of a cough. Oh, and a ten a day habit and a regular inhaler prescription.

Which last fact should have been a bit of a clue as to why she was in the chest clinic. And yet, somehow, the past six decades of medical advancement seem to have passed her by rather. It seems that when she was a young gel someone had told her smoking was a good and healthy thing to do, and she has stuck with that advice through thick and thin. The fact that she cannot now manage ten yards without gasping must surely be down to something else. And the angina she’s been getting for more than a decade. Everyone knows that’s all to do with cholesterol, and she’s taking her statins so that’s alright isn’t it. And anyhow the inhaler helps her to get about a bit better, and she never goes out anyway, hasn’t done for years, unless you count the shuffles to the newsagent for fags.

We do her lung function, just for fun, and it’s horrible. Effectively she has 20% of her predicted lung capacity and a “lung age” older than Metheusala. But still, her daughter-in-law intones, it would be cruel to try to stop her smoking. It’s the only bit of pleasure she has you know.

Would it be mean of me to speculate if dear Minerva is a woman of substance at this point?