Wednesday, February 24, 2010


It's finally happened. To be honest I'd half expected it, but still it's a bit of a shock to the system. Monday saw us all sitting around the table at coffee time dissecting the events of the weekend, and talk turned to Dr Neighbour's kids who are off doing the now almost compulsory world tour on a break between studies. They're able to keep in touch by mobile (sometimes) and by blog for the rest. Dr N is new to the bloggoshere and has found the whole thing a revelation, being able as she is to keep in touch with the kids adventures almost as they happen, in word and picture as well as (when monnies and signal permit) by voice.

We sometimes forget how much has changed this past decade. Even ten years ago, when a cousin of mine was doing the same thing, mobile coverage was less reliable and relatively massively more expensive, and most of us were still on good old fashioned steam powered dial up connections so the occasional email from Delhi or Addis Abbaba or wherever, was the most we could expect, and the the hard copy photo's pasted neatly into albums when processed and sorted after the prodigal's return.

So there we all were marvelling the wonders that modern tecnology and permanent web connection have brought when, from the other end of the table comes a voice-- "You've got a blog too haven't you Jesty!"

Back when I started this "stream of consciousness" rambling there were precious few medical bloggers, and especially GP blogegrs about. Not so now as a trawl through the blog rolls of some of my fellow bloggers will attest. I've always tried to keep this little corner of the net under the radar a bit, but being blogrolled by these same erudite colleagues means that inevitably one of my partners blundered across the caseblog some time ago, but till now hadn't thought to mention it.

I'm not overly surprised, but confess to being a little dismayed. It's not that I write stuff I think will upset them, it's just that from here on I'll be more directly aware of the presence peering over my shoulder. Right now I'm not sure what I think about that, but I suspect it will change the nature of our interaction in this virtual place, so I'm asking you all, regular and more recent readers, to bear with me while I figure it out.

Still it could be worse. At least I'm not a formerly cash strapped epidemiologist. Then again, I'll never be portrayed on screen by Billy Piper either.


Friday, February 19, 2010

Are you Joe Public?

In a recent email a very good friend of mine asked me to describe my “average” patient in response to a typically flippant remark I’d made. Which got me to thinking—never a good idea as we shall now discover. Inhabiters of this Sceptered Isle will I hope be familiar with the work of the comic genius that is Dave Gorman, a man who, on a drunken whim, set out to find 54 like named souls and in so doing brightened my life considerably one evening a week for six weeks as he described his search with stats and graphs and all sorts. This all happened a few years back, and if you know nothing of Dave or his quest I urge you to seek him out here.

As an homage (or ommmaaaje as I believe it’s pronounced on the other side of the pond) I offer the following.

The first thing to say, is that the “average” patient comes in two distinct but similar incarnations. Let’s call them Routine and Urgent. In an ordinary week Routines outnumber Urgents by 7:1. On a busier week, like this, the ratio is 3:1, though every third Routine is in fact a Semi-Urgent, but for today they will be appearing as Routines (largely because I can’t face doing the additional maths to separate them out). Right, now that's clear on we go.

So, for this week Ms Routine has been assiduous in his attendance, though her gender identity has been perhaps a little uncertain, being as he is 55% female. She’s a pleasing mix of ethnicities being 8% East European 24% Asian and 16% Afro-Caribbean leaving him roughly 52% indigenous to Borsetshire or Expatriate Brummie.

She’s been around 32% depressed—this prolonged cold spell, the recession and pre-election tension all taking a part in this slightly high statistic. He’s also been 16% Itchy—again mainly thanks to the cold, and 24% giddy. For the rest she’s been pretty much equal parts infectious and sprained. Oh, and he’s been 8% pregnant and 40 years old. And called Paul.

Mr Urgent has been, if anything a bit more confused, being 63% female. She’s 25% East European, 6% each Afro-Caribbean and Asian and a surprising 6% Viking. He’s also only 89% here. Her religious observance is confused, being as she is 6% Moslem, 6% Rastafarian and 24% Catholic. As to diagnoses he’s been suicidally low, had a bit of a cough, a nasty stinging when she—er… you know, and he’s been 18% pregnant—and called Samantha. And she’s 37 years old.

So there you have it, Paul and Samantha, Ms and Ms average. I'm sure you all recognize them.

Wednesday, February 10, 2010

Margot (Four little words.)

When Jerry first got the back pain that turned out to be myeloma Margot immediately rallied round, sorted his life out for him and got him to and fro for his chemotherapy like the trouper she undeniably is. After around eighteen months the chemo' was stopped, and the myeloma was declared in remission. Jerry wasn't quite the man he had been, but with Margot's help he got back on his feet and soldiered gamely on for five years before the disease came back again.

Sadly this is exactly what myeloma does. It's the cancer that breaks pretty much all the rules, especially the one that allows chemo' to work. Normally cancers grow more rapidly that anything else in the body. the chemo drugs poison growing cells (which is why they make your hair fall out). It also means you can give doses that will poison just the cancer cells and the hair follicles-- well mainly, and leave the rest of the patient in reasonable nick. Not so myeloma. It grows way more slowly that normal cells and tissues, so to kill it completely we'd have to kill the patients other cells and organs a number of times over, so we have to use pulses of chemo' to contain rather than cure.

In the end Jerry proved unequal to the fight and slid slowly into that good night around six years ago. And poor old Margot, having been utterly solid throughout his illness, finally fell apart. The first couple of years alone were really tough, even the arrival of a couple of grandchildren did little to lift her spirits. Anti-depressants did their bit to hold back the overwhelming tides of grief, and sheer dogged determination hauled her slowly out of the pit.

A couple of weeks ago she was back after an interval of almost twelve months, during which she'd successfully taken herself off the med's and was thriving. We talked it through, and time and the gradual demands of the same growing grand children had worked their inevitable magic allowing her to reconnect with the land of the living. She was smiling, and rightfully proud of herself. Then, just before she got up to leave she innocently asked those four little words, "While I'm here Doc..."

Anyone with any medical training will tell you how freighted with menace that tiny phrase can be. And so it was. She just wanted to mention this little pain she'd been getting in her chest, just for the past few months, just when she was climbing hills or stairs, or, as it's been lately, it got a bit cold.

So now poor Margot's off to see the cardiologist, but she still managed to leave the room smiling-- for the first time in years. I hope it lasts.