Thursday, December 31, 2009

Another year over...

... and lest face it, '09 hasn't been all that special. This can be a miserable time of year at the best of times, as I think I might have mentioned a time or two lately, and it's been noticeably worse this year. Over the past two weeks every surgery has seen at least two or three young adults in floods of tears as the dam bursts and they finally have to admit that they might really be depressed. Mostly it's been on a background of lost employment, failed relationships, mounting debt, and for many, a looming fear of homelessness of of having to go back to living with parents. Even this morning, in my last surgery of the year there have been another handful.

At times like this I am extremely grateful to be doing the job that I do in the place that I do it, but these are problems I'm powerless to directly influence. I can suggest that my poor victims try to throw themselves into something that they used to enjoy doing, that they try finding an outlet to talk about how they're feeling, and that they take the pills I'm about to offer them. What they need is a guarantee of a job, a prince / princess charming-- or at very least a kissable frog, a sizable lottery win, and a place of their own, and none of these things are in my gift.

So today I'm counting my blessings, and hoping that for all of us 2010 will mark an up-turn.

Thank you so much to all of you who read this nonsense, and all the more to those who are moved to comment. You really do all go a long way to keeping as sane I am ever likely to be. All the very best to all of you in the year to come, and God bless us, every one!

Monday, December 21, 2009

I'm dreaming of a white...

... sandy beach, sitting on a sun bleached deckchair, sipping ice-cold beer from a condensation covered glass, basking in thirty degree heat, and as far removed from the seasonal tyrrany of tinsel, turkey and kitsch that has become the Great American... er British Christmas.

If it seems like months now that we've been bombarded by ads with every B list "celeb" you can think of exhorting us to buy more food and booze than it's humanly possible to consume let alone enjoy (and lets face it half the crap they're peddling isn't even that enjoyable) that's because the run up to this next fortnight of saturnalian excess began in October. The pressure to indulge is overwhelming, and, not to put too fine a point on it, it's ruining the whole thing. The expectations now for this few days of "quality time" with the family are quite literally crushing, and it's making my punters irredeemably miserable. The only ones who have seemed at all cheerful have been the odd few who are taking this opportunity to jet for for an Antipodean Xmas with barbies on the beach and more sun than you can shake a boomerang at. Frankly I'm envious as hell. It doesn't help that this weekend we had temperatures of -5 centigrade (yes I know it's colder elsewhere, but once it gets anywhere below freezing it's inhumanly cold in my book), but it's more than that.

The expectation heaped onto this next few days is quite unreasonable, and must inevitably end in dissappointment, yet still we are all sucked in, lemming like, to the collective madness. When we come out the other side we'll still all owe tens of thousands to the economy that has tried to kid us for years that we can have something for nothing, the planet will still be melting, however counterintuitive that feels right here, right now, and all the attendant woes of famine plague and pestillence will continue. The unwinnable "War on Terror" will be grinding on its relentless way and our poor long suffering servicemen and women will still be struggling to deliver "peace with honour" in a conflict that offers neither, and will still be constrained to do so on a shoestring budget because we've poured all the cash away bailing out the banks. No so much "the economy, stupid!" as the "stupid economists". And us for believing in their voodoo.

If ever there was a time to take stock and rethink our priorities it's now. Not that we will. We'll all be too busy crowding out the stores and piling in supplies, one third of which we'll not use, and scrabbling around for those last minute gifts for "what's her name down the street that we thought wasn't going to give us anything this year but did".

So let me be the first to wish you Happy Next Christmas!

(Usual VECHN* for the closest guess to the date of my first "Happy Christmas" of the year from a punter)

*If you don't know what this is have a trawl through my misanthropoic back catalogue-- if you can be bothered at all, though I would'nt blame you for not. I'm in such a happy place right now. You can tell right?

Tuesday, December 15, 2009

It's the most wonderful time...

As the popular song has it. And full of wonder it must be to be sure. You see, for the next two weeks I and my humble wares become the infallible, guaranteed, absolute and only panacea for all ills. After all it's nearly Christmas, so we are transformed for a brief interval into a branch of the Elf Service and gifted healing powers normally reserved for song and fable. Well at least so it holds in the popular imagination.

The only problem is, unlike the jolly old man in red (courtesy of an early 20th Century Coca-Cola ad campaign apparently) we have to treat with all comers, both the "naughty" and "nice". A great many of both sorts crossed the Jesterly threshhold yesterday coughing, clutching sore throats or, more concerningly, grey cardboad vomit bowl "boaters". They all had some form of viral illness and fully expected I'd be in a position to cure it for them on the spot, or at least come up with an antibiotic to do it inside 48 hours so they can be ready for the fortnight long party that has become the "traditional" Ambridge Christmas we've all come to know and loathe... er... love.

And this particular year that's a hard contention to refute. After all viruses are now curable aren't they. There's that magical Tamiflu we've seen being dished out in bucketfulls for the swine flu, so if it's good for that how much the better will it do for a sore throat?

Well Mrs A, since you ask, not much. Indeed I'd not be allowed to prescribe it for Tyrone just now. You see, although he was "terribly ill" half a hour ago, he's now whirling round the consulting room like the Tazmanian Devil and looking even better than I feel. So no, I don't think his bit of a cough was the beginnings of flu, or pleurisy, or pneumonia... and no I don't think he needs Tamiflu, or Antibiotics, or fairydust. In fact I'm pretty sure he'll be fine for Christmas even if you leave him outdoors all day everyday till the big one itself.

And despite having wrapped himself in the paper bedroll like a demonically possessed Andrex puppy Tyrone was not the worst behaved of my little visitors yesterday afternoon. Nor the least ill.

Now it's true there are key events on the calendar that distort normal behaviour patterns and Christmas and New year are amongst the biggest. No-body is allowed to be ill for Christmas. And life is supposed to fantastically re-invent itself at New Year as we all resolve to do more of what we ought and less / none of what we didn't ought. The burden of this latter expectation can be overwhelming and it's no surprise that our colleagues in A&E and Mental Health services dread New Year as those so overhwelmed are bowled over by the tidal wave of their own expectations and driven to the edge of self destruction thereby.

I wonder, has it always been thus? Were the Druids besieged at Stonehenge by long lines of tartan clad celts on the eve of every solstice and equinox looking for a cure for that "bit of a cough" or that "Pilum head sticking out of my chest" before the drunken revels could begin in earnest? I'm guessing so, and if I'm right I'm also slightly comforted by the thought in a way that's rather hard to describe.

Monday, December 07, 2009

Letting go.

I've ranted about this topic before. After events of a week or two ago I might, possibly, be coming to change my view. A little.

Bill was 97. He'd been living in a nursing home for the best part of a decade. It was a nice home, well run, and he was cared for in every sense of the word. To start with he was just a bit older than the average resident, but down the years as faces came and went he gradually became the eldest.

When he went in he was just a bit wobbly on his legs, and a trifle vague on times and dates. Over the time his wobbliness had become worse, but his haziness lifted (largely because his previously unfettered access to sherry was rather more "managed"). Slowly he took to spending more and more of his days in the chair, but remained bright, alert and sociable.

Last year his ticker started playing up, odd missed beats now and again, then runs of palpitations, then the syncopated jazz riffs of atrial fibrillation. This tipped him over the edge and into heart failure-- an increasingly debilitating shortness of breath with attendant ankle swelling-- which he grew to hate, and perhaps to fear. We tried him with digoxin, diuretics and one or two other things with little benefit. In the end his heart just wasn't up for being pushed any harder, and he began to fade.

And so it was that with a heavy heart a few weeks ago I was called in to sit down with him and his family to ask the awful question, "if your heart stops what would you want us to do about that?" The home needed to know, partly because it's good practice these days, but mostly to make sure they could respect his wishes. In the event that we hadn't asked the standard assumption is that resuscitation will be attempted and paramedics will be called. Bill, quite rightly, didn't want any of this for him. As he put it "I had my three-score and ten some time ago and everything else has been interest."

Within a few days of our discussion Bill passed peacefully away with a daughter in attendance. It was almost as though he'd been looking for permission to let go.