Dr J waffles on

It's fair to say this blog has become a bit more of an occasional blog of late. This is unintended, and has a lot to do with me spending rather more time in the company of burly blokes in stab proof vests that I would ideally prefer. Still "you can't always get what you want" as the wise man once said. However it seems this chapter might be about to come to an end since the patient who warrants such tender ministrations is pondering a move to pastures new.

Actually, if I'm honest, there's not been that much to report on the surgery front lately either, other than our continued need for the intercessors with the stab proof vests being present a little more often than they would like too.

But hey, enough about my problems. How have you all been? What's new in your lives since last I rambled on at length about nothing in particular?

Oh, really, that's cool / so not cool/ great/ terrible/ interesting/ actually rather dull... (delete as inapplicable).*

So anyway, enough about you. I shall now resort to that old standby for days like this. Yes, you guessed it, a bit of waffle about the Today programme and the drive in to work.

Listening to the Today programme this past couple of days has been rather depressing. The picture they paint is of a health service that is irreparably broken. The sad thing is they might just be right.

In the last week we have had stories about the utter shambles that is the latest NHS jobs round for Junior Doctors. At the risk of committing Reductio ad absurdem, in brief, all junior Docs have a common training path for the first couple of years of their working lives. Having come out of med school primed with knowledge they get to serve a working apprenticeship learning properly how to BE a doctor. During this two years they are expected to form a clearer impression of the career they are looking for in medicine and then to start to apply for "proper" jobs that will fit them for their chosen speciality (or generality for us "square peg" types). Thus has it ever been since Hippocrates was accepting payment from his eager students for the passing on of his hard won knowledge and wisdom. Until this year.

Over the past few years a bunch of well intentioned boffins have been trying to sort out the yearly scramble for these "proper" training jobs. In doing so, somewhere along the way poor dear baby got flung out with the bath water. Now applicants cannot submit the time honoured (often slightly embellished to be sure) Curriculum Vitae to individual potential employers. instead they have all had to fill out, online, an application form so generic it has been impossible to tell either what their current training and aptitudes would best suit them for, or, indeed, even if they have any of the relevant qualifications necessary to pursue a career in any branch of Medicine at all. The system takes little or no account of their current situation personally, professionally or domestically. In endeavouring to be "fair" to all potential applicants, it appears the system has been evolved to be thoroughly unfair and arbitrary to all instead.

Things are so bad the West Midlands Surgeons have withdrawn from the whole shoddy business and are calling on other specialities and regions to do the same. Finally at the eleventh hour (or even at about five past twelve in the view of the tens of thousands of potentially affected juniors), the powers that be have agreed to look again at this unholy mess. Anyone with any interest at all in quality health care should watch this space. (Just don't hold your breath would be my advice).

Next we have had parallel stories of neglect and inappropriate management of wounded service personnel and the disabled when in hospital. Both stories go to underline the lack of training and even in many cases simple common sense, compassion and fellow feeling, prevalent on our wards these days. We have a culture of Graduate Nurses who often see themselves as "too posh to wash" left in charge of wards of needy and dependent patients, with scandalously inadequate staffing levels and no proper understanding of what "caring for patients" actually means. They can turn in an immaculately presented set of charts, and word perfect management plans, but as for actually feeding, cleaning or attending to their charges, well that hasn't been a priority on our wards for over a decade. Small wonder that there is a reported case of a handicapped patient literally starving to death during a three week hospital admission. Still we can all sleep easy tonight for Mrs Hewitt our esteemed Health Secretary is at last on the case.

OK, enough doom and gloom. This past two days Ambridge has been resplendent in sunshine for the morning drive to work. Yesterday in particular the drive was a splendid motoring experience. Every set of traffic lights was on green as I reached it, all the expected queues at roundabouts and junctions had been transported to some parallel dimension, in short I had an un-interrupted run in for the first time ever. Today's run started out less well with some pillock trying to jam a lorry under a bridge at Borchester railway station, but there after it was almost as pleasant, and better still the morning sun was good and low allowing me to don my ultra cool shades and become, for a blissful thirty minutes at least, the Road Warrior. Lakey Hill was bathed in a post apocalyptic, actinic glare of almost tangible global warmth as the Road Warrior gunned his mighty turbo diesel to one last heroic effort, careening down narrow ravines and across crumbling bridges on some primal errand of mercy or vengeance. Then it was nine o'clock and time to start surgery. Off with the leathers and shades and on with the motley....

* witness the effortless repartee that keeps me at the top of my game as a jobbing GP and Mountebank.

Open the window....

Looking back February was rather a thin month postingwise (probably not a "real" word but what the heck...). Seems it must have been busy. Thinking back fron the cosy distance of the 5th March it probably was actually. You see Ambridge has been stricken with a plague of Biblical proportions, and that despite being home to very few Pharaohs, or at least very few that I know to.

This year, for the first time in a decade or so we have seen significant numbers of folk with real honest to goodness 'Flu. And this despite being about as far away as it is possible to get from Norfolk and still be in England.

'Flu? I hear you say sneeringly. We know all about 'flu. We've seen the ads for Lemsip and Beechams. Those poor souls take a couple of capsules and are back on their feet in no time. What the heck is the matter with folk in Ambridge. Do they all have delicate constitutions like heroines in eighteenth century fiction perchance?

Well no. They don't. And here's a newsflash for you. Those ads you refer to, they lie. I know, shocking isn't it. But it's true. Those nice people in them are acting. They never had the 'Flu in the opening frames, so they had no trouble looking miraculously better by the close of the ad thirty seconds (or "in just three days!") later.

The real problem is that every year hundreds of folk hereabouts go down with a bad cold and call it "The 'Flu". After all it sounds so much better when they have been away from work for a few days. And yes they did feel grotty, perhaps snotty, definitely feverish, and porper poorly for a few days. Poor things.

But when they get the real thing, it's like they've been hit by a truck. Even opnening and closing their eyelids hurts. Death seems to lurk just beyond the doorway, and even after the first flush of lurgy has passed they are left feeling drained and lifeless as one of Dracula's hapless victims for weeks on end afterwards. And no amount of patent nostrum will do the trick.

But this can't be the 'Flu. After all those nice people in the ads got better so much quicker so this must be something much worse....

So for the benefit of those reading this who think they might have the 'Flu, let me just say this. You haven't. If you did, you wouldn't have had the energy to read it in the first place. Just take a Lemsip* and get on with it like they do on the telly. For those of you having it read to them because they feel too ill to read it for themselves, then yes, you might well have the 'Flu, but unless you have other more scary symtoms to go with it like very bad breathlesness or neck stiffness so severe you can't lift your head off the pillow then I'm afraid the best you can do is get whoever is reading this to get you a nice Lemsip* to take the edge off things and catch up on some much needed sleep. Of course if you are that breathless or stiff necked then you might be wise to call your Doc for helpafter all, and tell them I sent you.


* other cold and 'flu remedies are available.

"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.

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.

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!

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?

Gloom and despondency

Seems we have just lived through the “warmest” January on record. Now, forgive me, but the words “warm” and “January” to me do not belong in the same sentence*. Yesterday afternoon was a case in point.

Six of my eighteen booked surgery appointments were suffering with, or just beginning to come to terms with, severe depressive illness. It made the afternoon a bleak experience indeed. I normally expect one or two. It’s in the nature of my practice as one of the “cardy wearers” of the Ambridge Surgery. But in January, and most especially this January, it seems numbers escalate so the whole month has been a bit like this. Yesterday, as always, I hope they each felt they managed to be heard and understood, and that the changes in lifestyle and treatment we agreed will soon begin to take effect and put them all more firmly on a road to recovery. I’ll find out from them over the next two to four weeks. And by then it won’t be bloody January anymore, and this too might help in their recoveries.

Oddly, although the days are winding down to the shortest day, and the weather can be just as grotty, December never seems quite so bad. December is a “looking forwards” sort of a month. In Blighty we are all rushing about like headless chickens preconditioned from infancy to do the whole Victorian family Christmas thing. (This even appears to apply to my Moslem, Hindu, Jewish and, frankly, godless, acquaintances.) The whole Island seems to go into woolen-wrapped party mode. But January is a “looking backwards” month. It’s still cold. It’s still wet. There’s all the fuss around New Year and then the subsequent pressures we put ourselves under by resolving to be leaner-fitter-better-richer people than before, as though all that has gone before has somehow been not quite right, disappointing even.

Scientists have “proved” that within three weeks the cracks are already starting to show in these new-made resolutions for the vast majority and so the whole month becomes something of a let down. Still, it’s nearly February now and already in Ambridge at least things are beginning to feel quite spring-like.

This morning’s drive in to work was brilliantly illumined but a golden glow as the sun crept above the horizon turning the land pastel pink under a cornflower blue firmament dappled with fluffy white clouds. Bunnies were bunnying while squirrels squirreled and magpies went “Aaaaark!”.

Things might just be looking up.



*Would Southern Hemisphere readers please substitute January for June/July or whichever is your coldest month**.

** and would Tropically based readers just go with me on this or think “rain” when I drivel on about “cold” which I gather may be an alien concept….

The thin blue line.

Somehow "Can you speak to WPC Watmough about...." never seems to pressage good news. It's not WPC Watmough's fault. She just happens to be the one on shift who gets to make the call. It's honestly no better when any of her colleagues call either so it seems unfair to single her out, so lets pretend I didn't.

"Good morning WPC Watmough, how can I help?"

"Well Doc, it's Mrs Bloggs. She never came home last night and her family are worried. Is there anything you can tell us that might help?"

After a quick scan of her records there really isn't much. No real cardiac history. No past major psychaitric illness or current depression or anti-depressant medication. In fact no record at all since her annual flu jab in late October. I regrettfully inform the WPC of the facts, she thanks me and the day moves on.

That was Friday morning.

There was still no news of Mrs Bloggs by close of play on Friday. However this morning one of the younger Bloggses rang to inform us that all was well. It transpired that Mrs B had failed to make her Thursday Night Bingo appointment with friends. They had become concerned when there was still no sign of her at the end of the night and had phoned her home, to get no reply. After alerting first Ambridge and later Borchester Police, a Mrs Bloggs-Hunt was initaited, and after the deployment of at least one helicopter and dozens of officers Mrs B was duly fund, some miles from home and entirely unable to give an account of her last 24 hours.

She has spent a short stay in hospital for observation, and likely will require more investigations to try to better explain her nocturnal wanderings, but she is back, safe and sound in the bosom of the Bloggs family.

And all thanks to the care and dedication of WPC Watmough and her colleagues.

MMXIV

Blimey.

2014 visits since 19 December.

(I know a fair few were me in all honesty, but well done the rest of you and thank you all for stopping by).

It's been too long a day to be coherent, but I hope to be back on form next week.

And thanks again for taking the time to visit, and to comment when so moved. It's what helps keep me sane. Well sane-ish then....

As you were.

Smoke gets in your eyes.

Most New Years we see a brief rush of punters resolved finally to sort out their smoking / diet / other general health issues. They jam up the surgery for a week or so, competing for appointments with the dyspeptically over indulged and the early winter lurgy sufferers. Then they either relapse or decide they don’t need our help, and it all calms down again.

Not so this year. Oh no. Not by a long chalk. Still they come in their nicotine tarnished droves, wreathed in the smoke of their fiftieth absolutely-the-last-fag-I’m-ever-smoking-honest. I reckon I must have passively taken in the equivalent of a pack a day for the past three weeks, and it’s starting to make me feel a bit dizzy and sick rather like Virgil Tibbses (what is the correct possessive form of Tibbs I wonder?) son in the movie.

So why the sudden stampede of fumeurs desperate to quit? I hear you ask.

Well it’s all the “fault” of Her Brittanic Majesties Government. After nigh on a decade of prevarication they have finally decided to take the plunge and ban all smoking in public places from this coming July. At the same time day-time TV has been bigging up a new wonder drug to help quitters.

The only tiny problem with this is that no-one has bothered to actually tell us poor Tommies in the trenches about it. Good old Google informs me that it might well be called Champix, and that it probably is now licensed for NHS prescribing. But nowhere on our state-of-the-art clinical system with prescribing support software, bells, whistles and unicycling performing mice* is there any really useful information about how it should be prescribed or taken, what its mode of action might be (apparently, according again to Google, it makes smoking so boring people descend into a pit of hopelessness and despair and just quit) or indeed its side effects or interactions.

I do hope it will turn out to be better than Zyban (the last smoking cessation wonder drug- you remember, the one where the manufacturers sent round the helpful circular three months after the granting of the license saying “we know fifty odd patients have died taking our drug, but we reckon thirty of them at least would have died anyway, and at least most of them had stopped smoking like we said they would…”**).

Sorry must stop now, I feel a craving coming on.

Just send in the next smoker please!

* I think I might have hallucinated that last one. Pity, they were bloody clever performing mice too.

** O.K. they were a bit more scientific in their explanation, but that was the gist.

I've got a feeling we're not in Kansas any more!

Read any blog from Blighty written in the past 24 hours and it likely will mention the wind. Seems Ambridge has not been immune to the destabilizing effects yesterday's storm force winds had on the whole UK.

So now, today, in the post ictal calm that follows the aforementioned storm, I'm not quite sure where I am. And given my last consultation we may have been warped into a prallel dimension where the laws of Faerie apply, because I have just had a consultation with Cinderella. The fact that she came hobbling in wearing one high heeled fur* trimmed "slipper" should have been a bit of a clue. That and the fact her best mate was called Buttons...

But the awful truth is, like the fairytale character, this young lady has real confidence / assertiveness issues. Mum and Step-Dad both work long hours, and so are out of the house early in the morning, leaving poor Cinders to see to the care and feeding of her two younger step-brothers. Having got them up, dressed, fed, and ready for school she has to get of to school herself, faced with the prospect of doing the same things in reverse when she gets home.
So at home she is moody, tearful, not eating well, and Mum has decided she must be depressed. She's really not. She's just cross, hurt and fed up in equal measure, and with some justification.

Of course so far I only have this one side of the story, but from her presentation it really does appear that, like Cinderella, she has become "invisible" to her parents, and this lack of recognition and appreciation have effectively destroyed her emergent self esteem at a time when she is most vulnerable.

I have offered to meet with her and Mum to try to negotiate some sort of r'approchement, but I suspect her salvation may lie in the hands of a "man" in tights, with a thigh slapping habit and the matching fur trimmed slipper, given the way things are round here at the moment.

* Mrs Snell would want me to point out that the whole "glass slipper" thing comes from a sloppy translation from the French** story when the hapless translator took Vair for Verre and at a stroke turned fur to glass with nary so much as an alchemic grimmoire for assistance.

** She would further point out the origin of the tale is actually a Chinese fable of great antiquity appropriated by the French sometime after, and thence finding it's way to our shores.

Twilight

Enter Julia clutching a piece of paper.

She has known for years that here eyes are no longer what they were. She can often be seen in Tesco peering intently at labels, or tottering about town, weaving to avoid the lamp posts. But somehow, today she is different. And all through the power of her piece of paper.

It transpires that after her last consultation with her ophthalmologist* he decided it was time to put her name on the Blind Register. And that is what the paper tells her, or would do could she but read it. (I presume some kindly relative or passer by has read it to her because she does know the content before she comes in).

So that’s it then. She’s officially blind. She had never really thought of herself in those terms before, so the letter, far from being the simple administrative document intended, aimed at allowing her access to more assistance and support, instead drops on the mat a harbinger of doom, foreordaining the “dying of the light”.

Her driving license has already gone, some years ago, when her sight fell below the threshold for public and personal safety, as heralded by a small contretemps with a roadside tree. She has been in to audio books for years and is a familiar sight in the Library restocking her supply, and Eastenders and Corrie are now radio dramas for her. But blind, no, surely not. Just a bit foggy is all…

Until now.

What her specialist, quite rightly, saw as a kindly act, registering her so she can be properly assessed for the aids necessary to preserve her independence, has instead had an effect somewhat akin to the “black spot” of pirate lore. Now she’s had her letter the Angel of Death lurks round every corner, but at least she qualifies for a phone with huge buttons.

It took a good twenty minutes to persuade her that her sight was no worse since the letter came, and that being on “the register” did not mean she had to start being “ill”, just because her eyes have aged a bit quicker than the rest of her. Finally, and with a cheery farewell to the hat-stand as she passes she bustles off in search of more audio literature.

Not quite ready to “go gently into that good night” yet then.



* after a few stiff gins these chaps all become "eye specialists" for some reason.

Five things...

... you didn't know about me.

Having been tagged by the lovely Sooz and after some thought here goes:

1. My fledgeling acting career came to an abrupt halt at junior school when an unkind girl passed rude remarks about my Pharaoh's kilt, and the fact that it showed my pants. What a great artist the world lost* that day.....

2. That said I** did later perform a sell out gig in the Boston Symphony Hall. Yes, really, Boston Mass. not Boston Lincs.

3. Until age 14 I had always seen myself destined for a military career. So I could have been Colonel J by now. Brigadier even. That or dishonourably discharged.....

4. If I wasn't doctoring I would own and run a Hot Air Balloon business. If I knew anything about flying them, which I don't, had a fleet of support vehicles and a balloon, which I haven't, and didn't have to meet repayments on the mortgage for Jest Acres for the next 500 years, which I do... looks like it's more doctoring for me then.

5. I quite like venison***.

* Usual cyber hobnob for the first to spot the allusion.

** Well me and around 200 others. Did I mention I used to be in a choir?

***Which makes me descended from royalty, an outlaw, or possibly both.

Eating sweets can be bad for your knees.

I know what you’re thinking.

“No no no, that’s teeth surely? He means teeth doesn’t he? Yes it’s got to be teeth. Poor old thing’s gone a bit dotty. We should have seen it coming really, after all he’s been behaving a bit oddly for a while now. I expect it’s the rum truffles that finally tipped him over the edge….” and so forth.

But no. I do mean knees, or perhaps knee to be more exact, and prosthetic knee at that.

Allow me to explain.

A couple of days ago I saw a chap who had had a boiled sweet over the Christmas festivities. Hardly something to reproach him for you might think. And normally you would be quite right. But on this occasion things went rapidly “pear-shaped” as they say*.

You see the sweet in question shattered, lacerating his gum in several places. He gave the initial, albeit far from transient, pain little thought. However, by the next day he was beginning to feel a bit hot and a bit poorly. After a couple of days in bed with “the flu” the pain and heat settled in his knee replacement which remained hot and very very tender the day I saw him.

Now as anyone with any implanted prosthesis will tell you, they are all given a dire warning to watch out for gum injury during dentistry by seeking antibiotic cover. The thing is, even fairly minor gum injury, such as can be occasioned by the humble scale and polish, can introduce showers of bugs into the blood stream. From here the bugs can hop a ride like so many tourists on the underground, to any part of the body. They especially like prosthetics as they lack the normal defences of organic tissues.

So this poor lad appears to have a septic arthritis in his knee replacement and all for the sake of a boiled sweet.

I’ve told him to stick to chocolate in future. After all it’s kinder to the gums.

* In the absence of information to the contrary I am assuming the offending confection was a Pear Drop.

Why I can't play piano.

It was a lovely New Year weekend at Jest Acres. We saw the New Year in proper at midnight with a couple of left over fireworks from the November 5th debacle ( just combine the words “Whopping” “Rocket” and “Ground-burst” and you’ll get the gist), and then back into the warm to hootenanny along with Jools. The sit down banquet beforehand went spectacularly, helped no end by the two, yes I do mean plural here folks, chocolate fountains that had been separately gifted us by generous souls. The cava fizzed prettily as we “Auld lang syne’d” in ’07. After a rather late start to Monday we sat down to lunch at 2 and got up from the table at around 6.30, so you could say we’ve spent more hours in ‘07 feasting than sleeping so far!

There are now even the odd few gaps in the fridge which had not hitherto seen daylight this past ten days. (And the recycling bin clinked its tipsy way down the drive this morning when I put it out first thing, before setting out for the surgery. I myself have been, as you would all expect, the model of sobriety and decorum throughout this past festive season however.)

* Perceptive listeners will make out the strains of Tom Waits’ “The piano has been drinking” throughout that last parenthesis*

Then someone said it, late last night over rum truffles. (Well o.k. what really happened was that somebody tried adding rum to the preheated chocolate for the fountain and found out empirically how to make Rum Truffles- ahem…)


Specifically they said, “You ought to get one of them Blog thingies you know.”

So now I’ve had to perjure myself and I’m sitting here wondering if I feel more like Clark Kent or Anthony Burgess.

You see this thing only really works if I know no one I know is looking. If I thought for one minute they were then I’d go all self conscious and fat fingered and keep hitting all the black notes. So if you see them please don’t tell them or I might have to shut up shop.

Oh, and Happy New Year by the way.

Interview with the.....

... Ostritch.

And there you were thinking I was communing with the Undead. Sadly (?) the reality is far more mundane, but before that, more pithy and urbane musings on the state of the world at large and our little corner of Borsetshire in particular.

First, no matter when the "last-surgery-before-Christmas" happens to fall (Friday afternoon 22 December on this occasion) a weird phenomenon is to be observed. The surgery, which has been thereto a heaving mass of afflicted humanity sore in need of "the tablets", is transported wholesale to a parallel dimension. Wind howls across the deserted waiting room, sporting fitfully with the tumbleweed that appears from nowhere to fill the void. The phone, till now red hot in the operators hand, forgets all on a sudden how to ring.

Every five minutes or so someone feels the need to lift the receiver just to check, but there really is nobody there. (That should probably be "there really isn't anybody there" on reflection.)

The truth is, the whole of Ambridge has suddenly found something better to do with their time than be ill, and for most of them that means packing up work early and clearing off for the Holidays. Surgeries will be like this for the next fortnight, frequented only by lost souls who forgot to get "the tablets" in good time for Christmas, those unfortunates slated to work between the two holiday weekends who find themselves too hung over and in need of an exculpatory sick note, and the odd poorly person in amongst the others just to keep us on our mettle.

Second, if you can have "second" three paragraphs after "first", (makes mental note to look again at avoidance of circumlocution in New Year, I blame the reappearance of Ronnie Corbett on the telly, so anyway the producer said to me just now..... ) the roads of Borsetshire are bereft both of fog and of traffic. The same phenomenon that has whisked off the punters has done for all the road users in the county. Every single one. Except for sad specimens like the Bin Men and me. Somehow I quite like that juxtaposition though, especially since the Bin Men probably make more of a contributuion to public health on their weekly rounds than I do day to day in surgery. (And they helped me get to work in the guise of Gritter Lorry Men the year we had the blizzards, but that's a whloe 'nother story.)

Right, now that's off my chest as it were, back to business. Ruth brings in Ben and Josh today with a bit of a cough. You see Ruth is not a believer, and so failed to bring them in for the laying on of hands last week. As a result no-one in the household has slept for three nights because the lads have had a bit of a cough.

Every ten minutes or so.

All night.

They haven't even managed to synchronise paroxysms so that's every five minutes on average. All three pasty faces the other side of the desk look a trifle frayed. Or at least the two I can see properly do. Josh has decided, probably quite wisely, that he doesn't want to see the Jesterly "Christmas Jumper" in all its resplendent glory, and so has hands clamped firmly over his eyes.

With impeccable two year old logic, Josh figures if he can't see me then he too is invisible. He is disabused of this quaint notion by the cold bell of the stethoscope making contact with his back, but so long as I remain invisible, my stethoscope can't exist and it can't be happening so that's ok then isn't it. If he believes hard enough perhaps it'll go away. And so it does, in the end, as do the fingers feeling for "swollen glands" in the neck. The ordeal is all over.

Suddenly we can all become visible again, the hands drop and a pale but cheery Josh emerges into the light.

Later it occurs to me that Josh is simply enacting something we are all capable of metaphorically in this all too literal form. We all have things we perfer not to face, and so clamp our hands tight to our eyes, only to drop them when the visit to the dentist is over, the tax return is filed or the annual appraisal has been completed. Then we drop our hands, wonder what all the fuss has been about and carry on.

Until the next time.

A merry christmas to all our readers

Well that's about it. The last surgery before the festive weekend. Four days in the familial bosom to look forward to without the distraction of duty sessions. I have a couple of visits to do on the way out, and then those last few odds and ends to shop for, after that the festivities will commence in earnest, so this is likely to be my last post before Christmas.

So far it looks like Ambridge might be "White" for the holidays only in the sense that it will still be stuck firmly in the middle of a cloud. Still, this year Jest Acres has furnished a plentiful supply of holly and mistletoe with which to deck our halls, so we are having a "green" Christmas if anything.

Thanks to all readers and contributors down the past year, and may you all have a very happy and healthy Christmas. I hope that Santa brings you everything you wish for and your festivities are as cheery as we intend ours to be.

I'll hopefully be back on or soon after 27th December, but be warned we are off to Mrs Snell's Panto in the village hall on Boxing Day so I might still be in "sillier than normal" mode.

Oh yes I might.

Still by then it really will be "behind you!".

A light in the fog

We have moved through eldritch and whispy. Now we are swathed. So swathed the Motorways hereabouts are at a standstill. So the morning drive this morning, bearing in mind that Ambridge High Street is still shut, was even more of an adventure than normal. I felt like the poor herbert in the TA ad from a year or two ago, careening through the woods at night in his Landy as the instructor yells for him to kill the lights and keep going.

But this is ok, because this is the week I know I am untouchable. You see some kind of Christmas magic imbues GPs throughout the land this week, and I am, as are all my colleagues, at my most beatific.

"?" you rightly ask.

I shall ellucidate.

For this week only I have supernatural powers, right up there with the best of them. My very touch can heal. My stethoscope, normaly an humble diagnostic aid, becomes my magic wand, my wizards staff, my shamanic totem....

I know this because my faithful band of worshippers tell me so. They bring me their firstborn children for the laying on of hands*. They deluge me with cards telling me how great I am. I commune with the spirit world.**

Well, alright, really they bring in little Lilly and Freddy, to be "checked", so they wont be ill over Christmas. Still their faith is as touching as it is undeserved, as though my simple scutiny this week can ward off all evil. Would that it were,so. Still a lad can dream, and as you can probably tell, I rather like becoming one of Santa's helpers just for the week.

It's one of the fringe benefits of working for the Elf Service.


* and their second, third, fourth born, yea even unto the seventh generation.

** whereas lady doctors mainly get given sherry.

( This post now appearing at Shinga's excellent edition of Paediatric Grand Rounds mates.)

The fall and rise....

... of Doc J?

The powers that be have shut the main road through Ambridge this week. As a result of their thoughtlessness I have to take a more circuitous route in to work. This takes me down roads I used to commute on regularly, but have not visited in over a decade. It also gives more time for automphalopsy*.

The first thing that strikes me is how mutable our sub-urban landscape has become. Factories that had been standing by the roadside since the 1920’s when last I traveled this road, have vanished. The manufacturing has been outsourced to the Baltic I gather. In place of the factories we have “Rabbit Hutch” housing and apartment blocks that might have graced a 1980’s Bruckheimeresque Miami harbour-front, but which on a bleak Borchester December morning end up looking absurdly out of place. I mean, who in blighty can honestly say they get any mileage out of a balcony for god’s sake, specially a balcony 0.5m from a main road. I suppose if we were slightly more touristique in the summer they might come in handy for serving cream teas to the upper story occupants of open topped busses, but we’re not, and they won’t.

Now, having digressed almost as massively as I was detoured this morning, back to the main business of the day. Traveling these familiar yet unfamiliar roads took me back ten years or so to a fresher faced less worldly wise Dr J. The practice has come a long way since then, as have famille Jest. Most of it has been good. Some has been awful. On the whole though not a bad decade. But I can’t help feeling I’m slowly morphig in to a latter day Doc Morrisey**. I find myself saying in all earnestness to punters with lurgi, “Oh yes, I’ve had that too… wonder what it is?” or “Oh yes Mrs. Snell, there’s a lot of it about” or even, “Well if I were you I’d just keep on taking the tablets. Now tell me about the old love life….”.

Still, said with a knowing smile and tongue firmly planted in cheek I reckon that makes me post-modern. So that’s alright then.

*I googled this and so far it doesn’t seem to exist so I’m claiming ownership of it. It’s my neologism till proven otherwise. So there. (And a hob nob to the first respondent to correctly attribute it’s meaning) (And no, it’s not rude).

** I didn’t get where I am today by explaining obscure seventies sit com references.

Captain Scarlet

Captain Scarlet was, famously, indestructible. I reckon I know his mum.

Freda was in this morning. She is the far side of eighty, has had rheumatoid arthritis for all the time I have known her (and a decade or two before that too). She is also inclined to be a bit chesty—the product of a few too many woodbines, a habit picked up back when Herr Hitler’s boys were trying to do for her. She’s not actually smoked now for donkey’s years, but still lives with that legacy. So much so that in the autumn she went down with an acute pneumonia.

When I visited her and told her she would have to go in to the hospital for a day or two to start the intensive antibiotics she was going to need she looked crestfallen. The thing was, she was due to go to Spain to visit relatives ten days after my visit. I promised her we would try our best to get her fit for travel, and sure enough, ten days later and after just three days on IV antibiotics before converting to bucket loads of amoxicillin and steroids, she boarded her flight and convalesced in fine style.

Today she is back to review her steroid dose. She needs it tickled up a bit she tells me. This is because her arthritis has been a bit naughty since the weather has been getting worse again. And because she is fretting about her baby, now a grown woman of fifty-something, who goes in for a major operation next week. So Freda wants to be fit, so she can go and cook her son-in-law his Christmas dinner!

Knowing the world is peopled with characters like Freda helps me to sleep soundly in my bed at night. After all with such folk to protect us surely we have nothing to fear from the Mysterons!