Eddie came to the chest clinic this morning. His asthma is pretty well controlled with his present inhalers, and his lung function is appropriate for his age, and this despite his four decade smoking history. He says he would like to quit, but has tried all the methods available, with no lasting success. Still, this year he has decided to get serious and so, for Lent, he has given up.
Smoking.
Indoors.
Sadly, this behaviour modification has coincided with a bit of an upturn in the weather. In the past couple of weeks, Ambridge has been graced mainly by clear skies and brilliant sunshine or scattered, scudding clouds and a stiffish breeze. So in reality he’s not so much given up as changed venue.
Admittedly that makes it less likely that he will light up first thing, what with the rather frosty mornings such clear skies also cause; or last thing, since it’s still a bit nippy for standing on the patio in PJ’s, dressing gown and slippers. So this in part explains his drop from ten a day to six or seven. The problem is Lent will be up in another three weeks.
I’m also a bit baffled by the logic. Is it somehow more sinful to smoke indoors, polluting your own space, than outside, polluting everybody else’s? Or is God just watching what we get up to inside, knowing he can safely leave outdoors to Her Britannic Majesty’s Government, with their plethora of CCTV cameras and US loaned spy satellites? Or is this a new variation on the “calories don’t count if you’re standing up” argument?
I’m left wondering what other sins it might be safer to indulge outdoors, but, to be honest, so far I’m coming up blank.
Tuesday, February 26, 2008
Wednesday, February 20, 2008
The circus is in town.
Most of the time I’m more than happy to make do with a boring old mobile phone. The sort that just makes and receives calls. In fact, if I’m honest, I’m even more content to have the thing switched off in the glove box, or left back on the dresser at home. I know, I’m a grumpy old man, and I don’t care, so just get over it people.
Except that today I really, really wish I had one of those third generation, umpteen megapixel, all singing, all dancing, camera-phone-music-player-teasmade-filofax-blonde-bombshell-PA thingies. Because today I appear to have stepped through the looking glass and come out in Monty-Pythonland. You see, I know it’s not an acid flashback, ‘cos I never had the acid to flash forwards from in the first place, and yet the sight that greeted me on the way in to work this morning takes some explaining, and a picture really would have helped. I’m afraid you’ll just have to take my word for it instead. Still, you know you can trust me. After all I am a doctor….
I sense some of you in the cheap seats at the back getting restless. “Once again we haven’t got a clue what he’s talking about!” I hear you mumble above the background hubbub. I shall, at last, explain.
On the outskirts of town there’s a field (if I repeated this line now I might have a halfway decent beginning for a blues ballad—but we shan’t be going there today). In this field the are some sheep (yes, I know, “with a Baa Baa here an’a Baa Baa there”). So far so normal you might think, and so, on every other day it has turned out to be. But today these same sheep are auditioning for the Cirque d’Ambridge. In short they appear, gathered together in the corner of their field, in a seemingly perfect two-tier ovine pyramid, with a cluster of sheep at the base, and two very haughty specimens, side by side and faced Pushmipullyu fashion on the top tier.* So now you can see why I need a camera-phone.
Oh, and an in-car photographer, ‘cos otherwise all you’d actually get to see here would be a very fuzzy snap-shot of two headless sheepy blobs atop a mound of cotton wool.
*the boringly mundane reality is that the top layer sheep are standing on a very flat, very broad tree stump of an old, long ago felled, oak, with the remainder of the flock gathered in attendance around its circumference, which explanation rather spoils the illusion, but might help in my defense when the men in white coats come calling.
Except that today I really, really wish I had one of those third generation, umpteen megapixel, all singing, all dancing, camera-phone-music-player-teasmade-filofax-blonde-bombshell-PA thingies. Because today I appear to have stepped through the looking glass and come out in Monty-Pythonland. You see, I know it’s not an acid flashback, ‘cos I never had the acid to flash forwards from in the first place, and yet the sight that greeted me on the way in to work this morning takes some explaining, and a picture really would have helped. I’m afraid you’ll just have to take my word for it instead. Still, you know you can trust me. After all I am a doctor….
I sense some of you in the cheap seats at the back getting restless. “Once again we haven’t got a clue what he’s talking about!” I hear you mumble above the background hubbub. I shall, at last, explain.
On the outskirts of town there’s a field (if I repeated this line now I might have a halfway decent beginning for a blues ballad—but we shan’t be going there today). In this field the are some sheep (yes, I know, “with a Baa Baa here an’a Baa Baa there”). So far so normal you might think, and so, on every other day it has turned out to be. But today these same sheep are auditioning for the Cirque d’Ambridge. In short they appear, gathered together in the corner of their field, in a seemingly perfect two-tier ovine pyramid, with a cluster of sheep at the base, and two very haughty specimens, side by side and faced Pushmipullyu fashion on the top tier.* So now you can see why I need a camera-phone.
Oh, and an in-car photographer, ‘cos otherwise all you’d actually get to see here would be a very fuzzy snap-shot of two headless sheepy blobs atop a mound of cotton wool.
*the boringly mundane reality is that the top layer sheep are standing on a very flat, very broad tree stump of an old, long ago felled, oak, with the remainder of the flock gathered in attendance around its circumference, which explanation rather spoils the illusion, but might help in my defense when the men in white coats come calling.
Friday, February 15, 2008
Ars longa...
It’s a rather disappointing discovery to be sure. You see the exigencies of child care have occasioned me to take the middle three days of this past week off. In effect I have worked a two day week, namely Monday and today (Friday). Monday was a moderately busy Duty Surgery day, but the knowledge that this was to be followed by three days at home with the kids reduced the normal stress levels this would entail to near zero. And today, back for just a day before another weekend at home, has felt every bit as good.
I have been at my empathic best. I have explored every patient’s knowledge, expectations and concerns* to the uttermost. Dare I say it, I have even come over all “Peak Practice” on a couple of occasions.
All of which is leading me to the inescapable conclusion that far from being the macho, stress busting 24/7 Dr Kildare of the 21st century, I am in fact far more suited to the occasional commitments of the hobbyist, and well on the way to the pipe and slippers.
I think I feel a bit of a mid-life crisis coming on, and that’s a real blow. Especially since heretofore I was rather hoping to give Metheusala a run for his money, which would put the whole “mid-life” thing almost 440 years too soon.
Bugger.
Knowledge, expectations and concerns-- the "Holy Triad" or the Royal College of GPs, to be explored in every consultation. You know the sort of thing. " I know I've got a sore throat. I expect antibiotics. I'm concerned you won't let me have them."
I have been at my empathic best. I have explored every patient’s knowledge, expectations and concerns* to the uttermost. Dare I say it, I have even come over all “Peak Practice” on a couple of occasions.
All of which is leading me to the inescapable conclusion that far from being the macho, stress busting 24/7 Dr Kildare of the 21st century, I am in fact far more suited to the occasional commitments of the hobbyist, and well on the way to the pipe and slippers.
I think I feel a bit of a mid-life crisis coming on, and that’s a real blow. Especially since heretofore I was rather hoping to give Metheusala a run for his money, which would put the whole “mid-life” thing almost 440 years too soon.
Bugger.
Knowledge, expectations and concerns-- the "Holy Triad" or the Royal College of GPs, to be explored in every consultation. You know the sort of thing. " I know I've got a sore throat. I expect antibiotics. I'm concerned you won't let me have them."
Monday, February 11, 2008
Solar Power *
It’s been a bad month. You might have been able to tell, what with the total absence of posts and all.
No need to bother with the whys and wherefores. Most folk resident in Blighty might have some clue, although the press coverage of he latest spat between GP Land and Her Britannic Majesty’s Government hasn’t exactly been at the fore-front of the news agenda. Add that to the arrival of a new Student (whom I’m trying desperately to inoculate against the cynicism of my confreres—after all somebody’s got to step up to the plate and keep working to pay for my pension) and a rash of young adults bent on their own self –destruction, and overall the latter half of January through to now has been, in common parlance, “a bit of a bugger”.
And yet today, on the usual drive in to surgery, things somehow feel a little brighter. For one thing, half term is upon us, so no school run and no school traffic. Also all weekend, and again this morning, the sun has been shining, with nary a cloud in the sky. Daffodils are starting to nod in the verges, and a scattering of purple-pink crocuses dapple the floor of our own little wood at Jest Acres.
On the road to the surgery, roughly half way between Borchester and Ambridge, the road climbs sixty metres or so on to the Ambridge Escarpment. It’s a pretty enough stretch of road, but today, under Canaletto Blue skies suffused with the golden glow of the early morning sun, at this spot God is plainly in his heaven, and very little can be wrong with the world.
Governments come and go, as indeed do GP’s, students, suicidal teens and all the other trappings of modern existence. Yet some things still hint to us of eternity and perfection.
And in that context all the distractions of the past month boil away to nothing.
*For those who were wondering Dr J is indeed an unreconstructed hippie and flower-child who's formative years were profoundly affected by the Summer of Love. Not that you'd ever be able to tell nowadays.
No need to bother with the whys and wherefores. Most folk resident in Blighty might have some clue, although the press coverage of he latest spat between GP Land and Her Britannic Majesty’s Government hasn’t exactly been at the fore-front of the news agenda. Add that to the arrival of a new Student (whom I’m trying desperately to inoculate against the cynicism of my confreres—after all somebody’s got to step up to the plate and keep working to pay for my pension) and a rash of young adults bent on their own self –destruction, and overall the latter half of January through to now has been, in common parlance, “a bit of a bugger”.
And yet today, on the usual drive in to surgery, things somehow feel a little brighter. For one thing, half term is upon us, so no school run and no school traffic. Also all weekend, and again this morning, the sun has been shining, with nary a cloud in the sky. Daffodils are starting to nod in the verges, and a scattering of purple-pink crocuses dapple the floor of our own little wood at Jest Acres.
On the road to the surgery, roughly half way between Borchester and Ambridge, the road climbs sixty metres or so on to the Ambridge Escarpment. It’s a pretty enough stretch of road, but today, under Canaletto Blue skies suffused with the golden glow of the early morning sun, at this spot God is plainly in his heaven, and very little can be wrong with the world.
Governments come and go, as indeed do GP’s, students, suicidal teens and all the other trappings of modern existence. Yet some things still hint to us of eternity and perfection.
And in that context all the distractions of the past month boil away to nothing.
*For those who were wondering Dr J is indeed an unreconstructed hippie and flower-child who's formative years were profoundly affected by the Summer of Love. Not that you'd ever be able to tell nowadays.
Friday, January 18, 2008
One for Dr Freud
Eddie has been having some problems with neck pains. The pains have been with him for years, but until recently he was managing pretty well with regular painkillers. A bit before Christmas the pains got worse so we repeated some blood tests, looking for evidence of arthritis, and an x-ray.
The bloods were quite normal, but the x-ray has shown worn disks in a couple of places in his neck and these will undoubtedly be the cause for his pain. So he will press on with the painkillers. I did offer him physio, but he has tried this before and is not keen.
“I used to come here for it when you had that blonde girl upstairs. We did it three times a week, but I had to give it up ‘cos it hurt too much!”
Then he realized what he had just said, and neither of us could entirely suppress a schoolboy smirk.
Some days here it's just like being on the set of a Carry On film.
The bloods were quite normal, but the x-ray has shown worn disks in a couple of places in his neck and these will undoubtedly be the cause for his pain. So he will press on with the painkillers. I did offer him physio, but he has tried this before and is not keen.
“I used to come here for it when you had that blonde girl upstairs. We did it three times a week, but I had to give it up ‘cos it hurt too much!”
Then he realized what he had just said, and neither of us could entirely suppress a schoolboy smirk.
Some days here it's just like being on the set of a Carry On film.
Monday, January 07, 2008
Absent friend
Way back when, as one of my first tentative steps in compiling the rolling memoir that you now see before you, I wrote about an old friend and his best friend. My old friend Ray was back again today, this time on his own. Sadly, his best fried succumbed to a heart condition sortly after Christmas and is now serving guide dog duty for the choir invisible.
Ray reminds me that the initial consultation I described in the original post was almost a decade ago now, and yet the passing of his guide and companion still seems way too soon. Throughout the consultation we are reminded of the absence in the room as toys are not fetched to be deposited in either of our laps, and the "whumph" of a slightly pudgy labrador settling at his master's feet for the remainder of the consult is strikingly absent. No bowl of water appears at the door as once it did, and poor Ray is denied the fawning attention of one of our more dog mad reception team that was once his by right.
Happily this hiatus will not last for long as he has already been interviewed with a view to receiving a new companion. But for today we are left mourning the passing of a very special animal.
"The dog is a gentleman; I hope to go to his heaven, not man's." Mark Twain
Ray reminds me that the initial consultation I described in the original post was almost a decade ago now, and yet the passing of his guide and companion still seems way too soon. Throughout the consultation we are reminded of the absence in the room as toys are not fetched to be deposited in either of our laps, and the "whumph" of a slightly pudgy labrador settling at his master's feet for the remainder of the consult is strikingly absent. No bowl of water appears at the door as once it did, and poor Ray is denied the fawning attention of one of our more dog mad reception team that was once his by right.
Happily this hiatus will not last for long as he has already been interviewed with a view to receiving a new companion. But for today we are left mourning the passing of a very special animal.
"The dog is a gentleman; I hope to go to his heaven, not man's." Mark Twain
Friday, January 04, 2008
Winter Wonderland?
Overall it’s hard not to feel a bit swindled. The reports for the preceding forty-eight hours had been full of blizzard warnings for most of the known universe, or at least for dear old Blighty. And to be sure the East Coast did get a bit of a snowy pummeling.
We might have known when first the forecast started to slip from “Thursday” to “… around tea-time” to “… probably after seven”, that we were not to be blessed by so much as a solitary flake. Although actually I might have seen one or two playing fitfully on a chilly gust in the middle of the afternoon visiting round yesterday, or it might have been a slightly tardy post-hogmanay hang-overish sort of thing.
Instead today sees Ambridge submerged in the middle of a damp, clingy cloud of fog, and swept with successive bursts of fine cold drizzle. And the same cold, wet, numbing grip appears to have descended on the minds of most of the locals, or at least most of those attending surgery this past couple of days.
Fair to say, the rot had begun to set in on New Year’s Eve. It’s almost a cliché I know, but I can’t seem to get through a NYE surgery without encountering a least a couple of suicidally depressed patients presenting that day, for the very first time, and wanting everything sorted out right then. This year was no exception and it has sort of set the pattern for the past few days.
O.K. the high drama of NYE has been replaced by the dawning realization that we’ve all got another whole year ahead of us, so the actual impetus to self immolation has receded. Instead consultations seem to alternate between the flat, affectless and moping on the one hand, and the jittery, agitated, “free-floating” anxious on the other.
I can’t help noticing some of the patients seem a bit down in the dumps too.
We might have known when first the forecast started to slip from “Thursday” to “… around tea-time” to “… probably after seven”, that we were not to be blessed by so much as a solitary flake. Although actually I might have seen one or two playing fitfully on a chilly gust in the middle of the afternoon visiting round yesterday, or it might have been a slightly tardy post-hogmanay hang-overish sort of thing.
Instead today sees Ambridge submerged in the middle of a damp, clingy cloud of fog, and swept with successive bursts of fine cold drizzle. And the same cold, wet, numbing grip appears to have descended on the minds of most of the locals, or at least most of those attending surgery this past couple of days.
Fair to say, the rot had begun to set in on New Year’s Eve. It’s almost a cliché I know, but I can’t seem to get through a NYE surgery without encountering a least a couple of suicidally depressed patients presenting that day, for the very first time, and wanting everything sorted out right then. This year was no exception and it has sort of set the pattern for the past few days.
O.K. the high drama of NYE has been replaced by the dawning realization that we’ve all got another whole year ahead of us, so the actual impetus to self immolation has receded. Instead consultations seem to alternate between the flat, affectless and moping on the one hand, and the jittery, agitated, “free-floating” anxious on the other.
I can’t help noticing some of the patients seem a bit down in the dumps too.
Monday, December 31, 2007
Bonne Annee
So this is it then. Goodbye and, more or less, good riddance ’07.
It’s not been a specially great year here in Ambridge. A bit like the Nikkei, we’re closing the year a good few percentage points down. That said there have been highlights, both personal and professional along the way. It just seems they have been significantly outweighed by the lowlights this particular year. As a prime example, the year that began with exuberant chocolate fountains (yes I did mean plural) to a full house on New Year’s Day, goes out to a much more sedate chocolate fondue for five tonight, and for the first time ever we get two New Year celebrations exactly one hour apart, as one of our little flock will be celebrating Bonne Annee in mid exchange visit far away from the familial bosom.
(And if he doesn’t ring us close on the stroke of Minuit local time there’ll be ructions).
So all in all ’07 goes down in the Jest family annals as a bit of a damp squib.
We’re hoping for better in ’08, and despite the preceding misery (“the poor old lad’s come over all Seasonally Affective on us again” I hear you all shout, and you might have a point…) I would like to take the opportunity to wish all who tread here hereafter, the very best of years ahead.
And, of course, as much chocolate as you can comfortably accommodate ;-)
It’s not been a specially great year here in Ambridge. A bit like the Nikkei, we’re closing the year a good few percentage points down. That said there have been highlights, both personal and professional along the way. It just seems they have been significantly outweighed by the lowlights this particular year. As a prime example, the year that began with exuberant chocolate fountains (yes I did mean plural) to a full house on New Year’s Day, goes out to a much more sedate chocolate fondue for five tonight, and for the first time ever we get two New Year celebrations exactly one hour apart, as one of our little flock will be celebrating Bonne Annee in mid exchange visit far away from the familial bosom.
(And if he doesn’t ring us close on the stroke of Minuit local time there’ll be ructions).
So all in all ’07 goes down in the Jest family annals as a bit of a damp squib.
We’re hoping for better in ’08, and despite the preceding misery (“the poor old lad’s come over all Seasonally Affective on us again” I hear you all shout, and you might have a point…) I would like to take the opportunity to wish all who tread here hereafter, the very best of years ahead.
And, of course, as much chocolate as you can comfortably accommodate ;-)
Tuesday, December 18, 2007
For want of a nail...
Ivy has had a bad winter so far. She started coughing and wheezing in October. The cough has never really gone away, and after three courses of antibiotics (the last two with a steroid chaser) it is becoming apparent that her COPD has really taken a significant downturn, and now she is left breathless on minimal exertion.
And then, last Friday she arrived back at surgery in grip of another nasty respiratory virus. It’s still not exactly clear how she made it this far, because she arrived in extremis. Indeed after one look at her I was afraid she was on the verge of a respiratory arrest. With judicious use of the nebulizer we managed to get her breathing rate down to below sixty a minute and removed the awful dusky blue tinge from her lips and tongue, but she was plainly still in a lot of trouble and needed to go in to hospital to get sorted out, or at least to be assessed for oxygen therapy.
Except that there was no way to persuade her to go into hospital.
“You see I’ve got to get home to look after Mr. Tiddles.”
No,Ivy’s surname doesn’t even approximate to Tiddles.
She was, of course, referring to her cat, Mr. Tiddles the little black and white bundle of fluff she calls family. It appears her nearest relative lives about as far away from Ambridge as is possible and still be technically resident in Blighty, and may not be in the best of health either. Her closest neighbour on whom she might call is a sprightly ninety five, but not steeped in the lore of feline husbandry, and anyway “it wouldn’t …be right…. to impose … she has ….problems …enough.” All this between gasps which just go to underscore the imperative of Ivy’s admission to Ambridge General.
And so it is that Mr. Tiddles now has a daily entry in our home visit book for the duration of Ivy’s stay on the wards at A.G.H.
And then, last Friday she arrived back at surgery in grip of another nasty respiratory virus. It’s still not exactly clear how she made it this far, because she arrived in extremis. Indeed after one look at her I was afraid she was on the verge of a respiratory arrest. With judicious use of the nebulizer we managed to get her breathing rate down to below sixty a minute and removed the awful dusky blue tinge from her lips and tongue, but she was plainly still in a lot of trouble and needed to go in to hospital to get sorted out, or at least to be assessed for oxygen therapy.
Except that there was no way to persuade her to go into hospital.
“You see I’ve got to get home to look after Mr. Tiddles.”
No,Ivy’s surname doesn’t even approximate to Tiddles.
She was, of course, referring to her cat, Mr. Tiddles the little black and white bundle of fluff she calls family. It appears her nearest relative lives about as far away from Ambridge as is possible and still be technically resident in Blighty, and may not be in the best of health either. Her closest neighbour on whom she might call is a sprightly ninety five, but not steeped in the lore of feline husbandry, and anyway “it wouldn’t …be right…. to impose … she has ….problems …enough.” All this between gasps which just go to underscore the imperative of Ivy’s admission to Ambridge General.
And so it is that Mr. Tiddles now has a daily entry in our home visit book for the duration of Ivy’s stay on the wards at A.G.H.
Friday, November 30, 2007
Delusions of Grandeur
“He’s ready for you now” Miss Moneypenny nodded towards the office door, marked with typical ministerial frugality with a single letter-- M.
In I went, full of trepidation. Two hours later I emerged triumphant. Horizons had been scanned, forward motion was observed and a jolly nice Macedoin de Fruits analogy slipped in under the wire. All told I had shoe-horned in a grand total of five reader submitted buzz words or phrases. And more importantly, my Double-O status is safe for another year. The denizens of Ambridge can sleep safe in their beds, knowing that Dr J is on watch.*
So thank you to all contributors for your sterling efforts in making this year’s appraisal more amusing. It is possible there will be concerns at NHS management level about my sanity after the report goes in, but there’s probably nothing new in that anyway. I now expect my call up to visit Q branch for some new goodies any day, so just one question remains.
Where do I sign to get my new Aston Martin?
*Although actually of course night work and weekends are no longer in my purview…
In I went, full of trepidation. Two hours later I emerged triumphant. Horizons had been scanned, forward motion was observed and a jolly nice Macedoin de Fruits analogy slipped in under the wire. All told I had shoe-horned in a grand total of five reader submitted buzz words or phrases. And more importantly, my Double-O status is safe for another year. The denizens of Ambridge can sleep safe in their beds, knowing that Dr J is on watch.*
So thank you to all contributors for your sterling efforts in making this year’s appraisal more amusing. It is possible there will be concerns at NHS management level about my sanity after the report goes in, but there’s probably nothing new in that anyway. I now expect my call up to visit Q branch for some new goodies any day, so just one question remains.
Where do I sign to get my new Aston Martin?
*Although actually of course night work and weekends are no longer in my purview…
Friday, November 23, 2007
The dog et it......*
Brothers and Sisters I stand before you full of contrition. The thing is, the servers at work started playing silly buggers. Then things at home got a bit busy for a while. Then there was this whole clinical presentation to the entire practice thing that I had to get ready for Monday last, and finally the dread annual GP appraisal looming for Monday coming. In short these are my feeble excuses for the lack of posts (and comments elsewhere) this past few weeks.
Not that I haven’t been thinking of you all you understand. And now I’m back and already I’m after a favour.
“Bloody typical…” I hear you all muttering, “It’s always Me-me-me with him. We don’t know why we bother… honestly… “ and so forth. And you’re probably quite right. Still you can’t blame a chap for asking, so here goes.
As last year, next Monday morning I am to be appraised. A colleague and mentor will be stopping by for a chat, to try to detect if I have developed any homicidal tendencies since last we spoke. I’m pretty sure I haven’t, so that should be ok, but the whole process can be a bit of a travail. To lighten the mood last year we tried a game of “buzzword bingo”, a little something I shamelessly plagiarized from Blogger par excellence, Greavsie.
So what I’m looking for are a few choice buzzwords for this year. All suggestions gratefully received. Of course if you felt you wanted to submit them wrapped in a ringing endorsement stating how the Caseblog has transformed your sex life, cured that embarrassing little crop of warts, given meaning to an otherwise drab and hopeless existence, or other such fitting tribute, then however much it might embarrass me, you should give free reign to those feelings.
Just don’t tell anyone I asked…..
*excuse supplied to Mrs Badcrumble for non-appearance of homework, circa 1969. (And no we never did have a dog).
Not that I haven’t been thinking of you all you understand. And now I’m back and already I’m after a favour.
“Bloody typical…” I hear you all muttering, “It’s always Me-me-me with him. We don’t know why we bother… honestly… “ and so forth. And you’re probably quite right. Still you can’t blame a chap for asking, so here goes.
As last year, next Monday morning I am to be appraised. A colleague and mentor will be stopping by for a chat, to try to detect if I have developed any homicidal tendencies since last we spoke. I’m pretty sure I haven’t, so that should be ok, but the whole process can be a bit of a travail. To lighten the mood last year we tried a game of “buzzword bingo”, a little something I shamelessly plagiarized from Blogger par excellence, Greavsie.
So what I’m looking for are a few choice buzzwords for this year. All suggestions gratefully received. Of course if you felt you wanted to submit them wrapped in a ringing endorsement stating how the Caseblog has transformed your sex life, cured that embarrassing little crop of warts, given meaning to an otherwise drab and hopeless existence, or other such fitting tribute, then however much it might embarrass me, you should give free reign to those feelings.
Just don’t tell anyone I asked…..
*excuse supplied to Mrs Badcrumble for non-appearance of homework, circa 1969. (And no we never did have a dog).
Monday, November 05, 2007
Stop me if you've heard this one before.
“The thing is…” Nelson pauses for effect, “it doesn’t seem to matter what I do, I just can’t seem to stop putting weight on.”
Nelson has Type II diabetes. You know. The grown up sort. The kind that won’t put you into a coma in just a week or two, and, that seldom requires insulin at the start. One of the problems with this is that, in an effort to get his blood sugars to target, he has ended up on rather a lot of meds. And some of those meds can, paradoxically, cause weight gain. So he may just be experiencing a side effect.
“So,” say I, “what exactly have you tried?” A reasonable request I think you’ll agree. But Nelson’s body language comes over all discomfited.
“Well, I don’t have sugar in my tea anymore. And I’ve started using all those low fat thingies….” At this point his brow creases as he casts around for other lifestyle changes made in the three years or so he has been afflicted.
He dries.
“So have you tried dieting at all?”
The stunned look in reply says it all. It appears he was hoping for a visit from the “Weight Loss Fairies” to magic the excess avoirdupoids away.
And so we agree to give it a go. In the end he is weighing in a good three kilo’s heavier than he was in the spring, and this tips him over into the dread “Obese” category, which, coupled with his diabetes is not the best news. He has a target to make in the next four weeks, and if he can hit or get close to the required 2.5kg weight loss we shall be in a position to start him on some meds that might help (yes yet more meds, Type II Diabetes Mellitus is not for the faint hearted—‘scuse the pun).
If not he gets to go to the endocrine clinic for further advice.
Or we could always send in the Weight Loss Fairies...
Nelson has Type II diabetes. You know. The grown up sort. The kind that won’t put you into a coma in just a week or two, and, that seldom requires insulin at the start. One of the problems with this is that, in an effort to get his blood sugars to target, he has ended up on rather a lot of meds. And some of those meds can, paradoxically, cause weight gain. So he may just be experiencing a side effect.
“So,” say I, “what exactly have you tried?” A reasonable request I think you’ll agree. But Nelson’s body language comes over all discomfited.
“Well, I don’t have sugar in my tea anymore. And I’ve started using all those low fat thingies….” At this point his brow creases as he casts around for other lifestyle changes made in the three years or so he has been afflicted.
He dries.
“So have you tried dieting at all?”
The stunned look in reply says it all. It appears he was hoping for a visit from the “Weight Loss Fairies” to magic the excess avoirdupoids away.
And so we agree to give it a go. In the end he is weighing in a good three kilo’s heavier than he was in the spring, and this tips him over into the dread “Obese” category, which, coupled with his diabetes is not the best news. He has a target to make in the next four weeks, and if he can hit or get close to the required 2.5kg weight loss we shall be in a position to start him on some meds that might help (yes yet more meds, Type II Diabetes Mellitus is not for the faint hearted—‘scuse the pun).
If not he gets to go to the endocrine clinic for further advice.
Or we could always send in the Weight Loss Fairies...
Monday, October 22, 2007
If you go down to the wood today...
The ghost of Monty Python is apparently abroad. Or to put it another way I’ve just had another of those completely surreal consultations that leave me marveling on the vagaries of the human character and chortling quietly to myself.
The first clue that things were going to be less than straightforward was Lynda’s admission right at the outset that she was “… in a bit of a mess.” Lynda is a woman of middle years, and not generally prone to euphemism. The second clue passed me by at first, but on the desk she had deposited her car keys—nothing unusual in that—hanging from a cutesy teddy bear key-ring.
It transpired that a few weeks ago Lynda had an intimate liaison with a “new partner”. Or a good old fashioned one night stand to be more accurate. Some weeks on she was left with a continuing reminder of the same, and requires investigation to rule out STI. We agreed that rather than refer her straight to the GU clinic, to spare her blushes we could initiate investigations here and only refer if we found a complicated case of infection. From her symptoms the most likely culprit remained candida and so the full rigours of the GU clinic might well be unnecessary.
So as I was completing the microbiology form to arrange the requisite swabs, I happened to glance over to where teddy lay resplendent on the desk. There he lay in all his glory. I can assert his masculine gender with some certainty, since there he was hung quite literally “like a bear” and with a “Prince Albert” to boot. Keeping a straight face through the remainder of the consultation was a real challenge I must say…
The first clue that things were going to be less than straightforward was Lynda’s admission right at the outset that she was “… in a bit of a mess.” Lynda is a woman of middle years, and not generally prone to euphemism. The second clue passed me by at first, but on the desk she had deposited her car keys—nothing unusual in that—hanging from a cutesy teddy bear key-ring.
It transpired that a few weeks ago Lynda had an intimate liaison with a “new partner”. Or a good old fashioned one night stand to be more accurate. Some weeks on she was left with a continuing reminder of the same, and requires investigation to rule out STI. We agreed that rather than refer her straight to the GU clinic, to spare her blushes we could initiate investigations here and only refer if we found a complicated case of infection. From her symptoms the most likely culprit remained candida and so the full rigours of the GU clinic might well be unnecessary.
So as I was completing the microbiology form to arrange the requisite swabs, I happened to glance over to where teddy lay resplendent on the desk. There he lay in all his glory. I can assert his masculine gender with some certainty, since there he was hung quite literally “like a bear” and with a “Prince Albert” to boot. Keeping a straight face through the remainder of the consultation was a real challenge I must say…
Monday, October 15, 2007
Welcome to Tombstone!
First a small matter of house keeping. It appears that after fifteen years the domain that also supplied my email address has been withdrawn. My very kind ISP have supplied me with a shiny new domain of my own and a new mail account to go along with it, so for those who feel the need to know, I can now be reached at “the-doctor-is-in(AT)doctorjest(DOT)co(DOT)uk”
Now on with the motley….
I’ve seen some pretty odd indications for admissions to nursing homes in the past. On at least a couple of occasions we have had to admit patients to a local Home for healing of their pressure sores (it helped that the Home’s matron was at the time an internationally published authority on the subject and a true mistress of her craft, thus disproving the old axiom that “those that can’t teach”).
We have also felt in necessary, on more than one occasion, to admit frail patients to nursing homes rather than to hospital to keep them away from the Jabberwock strains of MRSA or C. Difficile (prn dif-ik-illy not dif-iss-eel it’s LATIN people!). There was even one occasion when I admitted a chap to get him away from the maggots (we are talking real live wigglies here, not the Lovecraftian imaginings of a diseased mind).
Still today’s notification takes things to a whole new level. I have a patient who was recently admitted to a nursing home for her own safety after a fist fight developed between her family and her carers.
From now on I’m thinking of changing the old monicker to Doc Holiday.
Now on with the motley….
I’ve seen some pretty odd indications for admissions to nursing homes in the past. On at least a couple of occasions we have had to admit patients to a local Home for healing of their pressure sores (it helped that the Home’s matron was at the time an internationally published authority on the subject and a true mistress of her craft, thus disproving the old axiom that “those that can’t teach”).
We have also felt in necessary, on more than one occasion, to admit frail patients to nursing homes rather than to hospital to keep them away from the Jabberwock strains of MRSA or C. Difficile (prn dif-ik-illy not dif-iss-eel it’s LATIN people!). There was even one occasion when I admitted a chap to get him away from the maggots (we are talking real live wigglies here, not the Lovecraftian imaginings of a diseased mind).
Still today’s notification takes things to a whole new level. I have a patient who was recently admitted to a nursing home for her own safety after a fist fight developed between her family and her carers.
From now on I’m thinking of changing the old monicker to Doc Holiday.
Wednesday, October 10, 2007
Gosh, look at all these trees!
Bert’s angina has been playing him up. Over the past few years he has been a diligent attender at the CHD clinic, and his blood pressure, cholesterol, glucose et al are all perfectly managed. He takes his allotted and guideline mandated handfuls of pills as required. In short, Bert is a model patient, and he is managed to the last scintilla exactly to protocol.
As a result, he is a bit put out to find his angina back again. It isn’t that severe. He can still manage hills and stairs pretty well. He just has to remember to pace himself a little better. And if he forgets (because inside he still feels closer to twenty eight than to his chronological “pushing eighty”) he gets a short sharp reminder. Given that he had been symptom free for much of the past three years this has come as a bit of an imposition, and he is keen to learn what I am going to do about it.
“These pills are no help at all!” he says, brandishing a green and white packet at me. It’s not one I immediately recognize, and with all the waving I can’t quite manage to read the tiny stick on pharmacy label that would inform me as to which precise anti-anginal medication has been letting him down. I take the packet off him, and call up his current meds on the screen. The box contains his statins (cholesterol meds useful for preventing further deterioration—but not for relieving the pain of angina when it hits). The screen shows he has no regular anti-anginal medication. But then, until the past few weeks he has not has regular angina either…
The screen shows his last script for any angina reliever medication was over two years ago, and this has long run out.
So he leaves with a script for a new spray, and my encouragement that he ought also to continue his statin and other meds as well. He’s also going to have a few follow on tests to make sure he hasn’t become worse, but all the evidence of his last investigations shows things were quite stable within the last three months.
I am a little troubled that both he and we have slightly lost the plot here. After all he did already have angina when he began attending the CHD clinic , and for all the preventives he is now receiving, it remains the case that his pre-existing ischaemia will, from time to time, make itself known, and when it does it is quite o.k. for him to react to this with reliever medication. It seems we both need to learn to see the wood again, as well as focusing on the trees...
As a result, he is a bit put out to find his angina back again. It isn’t that severe. He can still manage hills and stairs pretty well. He just has to remember to pace himself a little better. And if he forgets (because inside he still feels closer to twenty eight than to his chronological “pushing eighty”) he gets a short sharp reminder. Given that he had been symptom free for much of the past three years this has come as a bit of an imposition, and he is keen to learn what I am going to do about it.
“These pills are no help at all!” he says, brandishing a green and white packet at me. It’s not one I immediately recognize, and with all the waving I can’t quite manage to read the tiny stick on pharmacy label that would inform me as to which precise anti-anginal medication has been letting him down. I take the packet off him, and call up his current meds on the screen. The box contains his statins (cholesterol meds useful for preventing further deterioration—but not for relieving the pain of angina when it hits). The screen shows he has no regular anti-anginal medication. But then, until the past few weeks he has not has regular angina either…
The screen shows his last script for any angina reliever medication was over two years ago, and this has long run out.
So he leaves with a script for a new spray, and my encouragement that he ought also to continue his statin and other meds as well. He’s also going to have a few follow on tests to make sure he hasn’t become worse, but all the evidence of his last investigations shows things were quite stable within the last three months.
I am a little troubled that both he and we have slightly lost the plot here. After all he did already have angina when he began attending the CHD clinic , and for all the preventives he is now receiving, it remains the case that his pre-existing ischaemia will, from time to time, make itself known, and when it does it is quite o.k. for him to react to this with reliever medication. It seems we both need to learn to see the wood again, as well as focusing on the trees...
Wednesday, October 03, 2007
In which Dr J has a bit of a moan...
This post has been quite hard to write and might be equally so to read. I’m afraid you’ll have to take my word for it that in no way is it intended as a whinge, however it turns out…
Tony called yesterday to update me on his progress. He was effusive in his praise of the surgery, and of the hospital team he was referred to. In charming and measured tones he took me through his last few weeks, from my referral to the initial surgical outpatients appointment just a few days after. Thence to CT scanning and back to a different, oncology, outpatients appointment where they gave him the expected news, that he did indeed have a carcinoma, and that it was too invasive and widespread for surgery. He goes for palliative radiotherapy in the near future.
He appreciates that the prognosis is poor, and yet is quite unreasonably grateful to the team that have made the diagnosis and given him that information. It may sound surprising, but in my experience such innate nobility and generosity of spirit is not at all unusual. Indeed I would go so far as to say I often feel most appreciated* by those patients for whom I can do the least.
Annoyingly, the converse is also often true, and patients for whom one has attempted impossible feats of logistics, who have then accessed the specialist of their , often quite unreasonable, choice and undergone the high tech intervention for whatever problem they have presented, return to moan about delays in treatment, parking problems and the quality of the hospital food. After consultations like this you will find me tearing what little remains of my hair out, and wondering just why it is I heave myself out of bed each morning to come here...
And then Mrs Archer will wander in for a review of her Diabetes and High Cholesterol, and with a twinkle in her eye, and not a hint of irony, hand over a box of Clotted Cream Fantail Shortbread, “for you Doctor, from my holidays…”.
Well at least it helps explain her sugars and cholesterol!
*Such utterly unwarranted appreciation comes with a large slab of guilt on the side.
Tony called yesterday to update me on his progress. He was effusive in his praise of the surgery, and of the hospital team he was referred to. In charming and measured tones he took me through his last few weeks, from my referral to the initial surgical outpatients appointment just a few days after. Thence to CT scanning and back to a different, oncology, outpatients appointment where they gave him the expected news, that he did indeed have a carcinoma, and that it was too invasive and widespread for surgery. He goes for palliative radiotherapy in the near future.
He appreciates that the prognosis is poor, and yet is quite unreasonably grateful to the team that have made the diagnosis and given him that information. It may sound surprising, but in my experience such innate nobility and generosity of spirit is not at all unusual. Indeed I would go so far as to say I often feel most appreciated* by those patients for whom I can do the least.
Annoyingly, the converse is also often true, and patients for whom one has attempted impossible feats of logistics, who have then accessed the specialist of their , often quite unreasonable, choice and undergone the high tech intervention for whatever problem they have presented, return to moan about delays in treatment, parking problems and the quality of the hospital food. After consultations like this you will find me tearing what little remains of my hair out, and wondering just why it is I heave myself out of bed each morning to come here...
And then Mrs Archer will wander in for a review of her Diabetes and High Cholesterol, and with a twinkle in her eye, and not a hint of irony, hand over a box of Clotted Cream Fantail Shortbread, “for you Doctor, from my holidays…”.
Well at least it helps explain her sugars and cholesterol!
*Such utterly unwarranted appreciation comes with a large slab of guilt on the side.
Friday, September 28, 2007
"The Pills"
Mrs Antrobus has the gout. She had it a few months ago and hobbled along to see Dr Neighbour. He, quite rightly, gave her Indocid (a shiny new Non-Steroidal Anti-inflammatory Drug – NSAID for short). Of course, by new here I mean invented during the latter half of the last century, but in overall terms that’s quite new really.
It worked like a charm for the gout. Only problem, it made poor Mrs A feel terrible: queasy, giddy, sore-tummied, tight-chested, in short pretty much all the listed side effects short of massive and life threatening gastrointestinal haemorrhage. She almost preferred having the gout.
This is a shame, because, and I can speak here from personal experience, when it works and is tolerated Indocid can be a great help. Still it appears Mrs A is particularly sensitive to the side effects of NSAIDs and so we perhaps should avoid them for the future. But Mrs A has the gout. Again. It’s time, to coin a phrase, to “get mediaeval on it’s a**e”. No more Dr Nice-Jest!
You see, for all our modern sophisticated scientific method, sometimes you just have to go the apothecary route. It’s time to wheel out the Autumn Crocus. More properly, time to wheel out that extract of the aforementioned known to our ancestors as colchicine. It’s a difficult drug to use because it can be quite toxic, causing vomiting and diarrhoea. Indeed the dosing instructions contain the comforting advice “take Ye until ye paine hath abayted or peradventure it happeneth that ye patient vomiteth or suffereth an flux of ye bowelf, prithee”, or words to that effect. It’s also a bit of a pain having to go back to prescribing in grains and drachms, but, for all that, it can and often does work every bit as well as the shiny new drugs, and is often better tolerated.
I have this mental image that the drug is prepared by tonsured and habited apothecary friars sequestered in sheds at the bottom of monastery gardens, dispensing antique wisdom and solving the odd ecclesiastical murder. Somehow I suspect this is no longer the case, but it suits my fancy to continue in my delusion, and to delight in turning the clock back a few centuries once in a while.
Prithee.
It worked like a charm for the gout. Only problem, it made poor Mrs A feel terrible: queasy, giddy, sore-tummied, tight-chested, in short pretty much all the listed side effects short of massive and life threatening gastrointestinal haemorrhage. She almost preferred having the gout.
This is a shame, because, and I can speak here from personal experience, when it works and is tolerated Indocid can be a great help. Still it appears Mrs A is particularly sensitive to the side effects of NSAIDs and so we perhaps should avoid them for the future. But Mrs A has the gout. Again. It’s time, to coin a phrase, to “get mediaeval on it’s a**e”. No more Dr Nice-Jest!
You see, for all our modern sophisticated scientific method, sometimes you just have to go the apothecary route. It’s time to wheel out the Autumn Crocus. More properly, time to wheel out that extract of the aforementioned known to our ancestors as colchicine. It’s a difficult drug to use because it can be quite toxic, causing vomiting and diarrhoea. Indeed the dosing instructions contain the comforting advice “take Ye until ye paine hath abayted or peradventure it happeneth that ye patient vomiteth or suffereth an flux of ye bowelf, prithee”, or words to that effect. It’s also a bit of a pain having to go back to prescribing in grains and drachms, but, for all that, it can and often does work every bit as well as the shiny new drugs, and is often better tolerated.
I have this mental image that the drug is prepared by tonsured and habited apothecary friars sequestered in sheds at the bottom of monastery gardens, dispensing antique wisdom and solving the odd ecclesiastical murder. Somehow I suspect this is no longer the case, but it suits my fancy to continue in my delusion, and to delight in turning the clock back a few centuries once in a while.
Prithee.
Wednesday, September 26, 2007
I read the news today.... oh boy!
A while ago Orchidea asked what it feels like being the harbinger of bad news. What follows is my best attempt at a succinct(ish) reply.
Students these days spend a lot of time learning about 'breaking BAD NEWS' along with other essential communication skills. We old sweats had to pick these things up the hard way. In reality I'm not so sure we didn't get the better deal though. The thing is, there ae just too many variables you need to factor in to being an effective harbinger. In my view it is damn near impossible to role play this particular scenario effectively, simply because none of the actors involved (one hopes) can truly have any concept of the stakes involved.
The dramatic conventions of stage and screen would dictate that each such occasion is played to the hilt, with everyone in the room wearing their heart on their sleeve and the whole spectrum of grief played out in a few short minutes. As with so much else in life, reality is somewhat at variance with high drama, or even with soap opera. Life, even the end of life, is a continuum. Our scene does not begin with the director shouting 'action'. Neither does it end with the close of the office, or house, front door.
Furthermore, a great many of those for whom the bad news is intended are merely having their own impressions confirmed. Granted this is not the case for all, but my own experience has it at a significant majority. Factors such as faith, ethnicity, family support, prior family history, and both the patient and their families past life experiences all need to go into the melting pot.
Next one has to consider the relationships already built up between doctor and patient (be they good or ill), their connection to the wider practice and community, and to their hospital consultants, teams and specialist units.
From all of the above, it should be pretty clear that there can never be a one size fits all approach to the harbinger business, and we risk confusing juniors, having them believe the whole 'Bad News' agenda has been dealt with in half a day of safe and cosy roleplay.
Now, returning to the question, I have two answers that at first blush may seem rather a cop out. I hope I can show you they are not.
The first and simplest answer is 'never good'. I am frequenly accused of having a penchant for stating the bleedin' obvious, but I fear it needs stating anyhow. With all the evidence presented, when faced with a life threatening diagnosis, it can feel rather as though you sit as judge, jury and executioner dishing out arbitrary and summary 'justice'. This feeling can be even worse if, with the 'benefit' of hindsight you feel the diagnosis was in any way delayed. And it can feel worse still if you have come to know the patient very well, or, ironically, not well enough.
Which brings me to the second and rather woolier answer. The act of delivering such a verdict, as previously aluded to, is interactive, with at least two participants. As a result the scene, though it shares a number of common threads, feels different every time.
For the majority of patients as I said before, you are simply confirming their own impression. It takes some pretty spectacular mental gymnastics to live for any length of time with a significant and potentially life threatening diagnosis, and not to at least guess that somthing is amiss. It can, and occasionally does happen, and when it does we can stray into the sphere of high drama.
But for most folk, with most significant diagnoses, you move speedily from 'what' it is to 'how' to make it go away / stop hurting / slow down. This is where one turns from simple messenger to true harbinger.
O.K. I'll admit, I had to go and look it up. I had always assumed the two terms were near interchangable, all be it that harbingers carried more portentous news, harbinging as they commonly do, Doom, or Spring or some other word requiring a capital letter. And so indeed they do, or did, but they do much more than simply foretell an arrival. They are the fore-runners, the attendants sent out ahead of notable personages to prepare the way. It is their job to see to it that shelter is arranged and that provisions will be on hand to sustain and refresh their charges.
So in the imparting of bad news it behoves us to think about the aftermath, and be ready to reach out and offer what shelter and sustenance we can. Where there is hope of recovery, however slight, we must be sure to offer that hope. And where there is none, we must make it plain that there is still much that can be done to offer comfort and support for as long as it will be needed.
And in doing this well, however painful the message can be both to give and, more particularly, to receive, by showing that we can and will always try to prepare the way, it is possible to take some pride in being an effective harbinger.
Students these days spend a lot of time learning about 'breaking BAD NEWS' along with other essential communication skills. We old sweats had to pick these things up the hard way. In reality I'm not so sure we didn't get the better deal though. The thing is, there ae just too many variables you need to factor in to being an effective harbinger. In my view it is damn near impossible to role play this particular scenario effectively, simply because none of the actors involved (one hopes) can truly have any concept of the stakes involved.
The dramatic conventions of stage and screen would dictate that each such occasion is played to the hilt, with everyone in the room wearing their heart on their sleeve and the whole spectrum of grief played out in a few short minutes. As with so much else in life, reality is somewhat at variance with high drama, or even with soap opera. Life, even the end of life, is a continuum. Our scene does not begin with the director shouting 'action'. Neither does it end with the close of the office, or house, front door.
Furthermore, a great many of those for whom the bad news is intended are merely having their own impressions confirmed. Granted this is not the case for all, but my own experience has it at a significant majority. Factors such as faith, ethnicity, family support, prior family history, and both the patient and their families past life experiences all need to go into the melting pot.
Next one has to consider the relationships already built up between doctor and patient (be they good or ill), their connection to the wider practice and community, and to their hospital consultants, teams and specialist units.
From all of the above, it should be pretty clear that there can never be a one size fits all approach to the harbinger business, and we risk confusing juniors, having them believe the whole 'Bad News' agenda has been dealt with in half a day of safe and cosy roleplay.
Now, returning to the question, I have two answers that at first blush may seem rather a cop out. I hope I can show you they are not.
The first and simplest answer is 'never good'. I am frequenly accused of having a penchant for stating the bleedin' obvious, but I fear it needs stating anyhow. With all the evidence presented, when faced with a life threatening diagnosis, it can feel rather as though you sit as judge, jury and executioner dishing out arbitrary and summary 'justice'. This feeling can be even worse if, with the 'benefit' of hindsight you feel the diagnosis was in any way delayed. And it can feel worse still if you have come to know the patient very well, or, ironically, not well enough.
Which brings me to the second and rather woolier answer. The act of delivering such a verdict, as previously aluded to, is interactive, with at least two participants. As a result the scene, though it shares a number of common threads, feels different every time.
For the majority of patients as I said before, you are simply confirming their own impression. It takes some pretty spectacular mental gymnastics to live for any length of time with a significant and potentially life threatening diagnosis, and not to at least guess that somthing is amiss. It can, and occasionally does happen, and when it does we can stray into the sphere of high drama.
But for most folk, with most significant diagnoses, you move speedily from 'what' it is to 'how' to make it go away / stop hurting / slow down. This is where one turns from simple messenger to true harbinger.
O.K. I'll admit, I had to go and look it up. I had always assumed the two terms were near interchangable, all be it that harbingers carried more portentous news, harbinging as they commonly do, Doom, or Spring or some other word requiring a capital letter. And so indeed they do, or did, but they do much more than simply foretell an arrival. They are the fore-runners, the attendants sent out ahead of notable personages to prepare the way. It is their job to see to it that shelter is arranged and that provisions will be on hand to sustain and refresh their charges.
So in the imparting of bad news it behoves us to think about the aftermath, and be ready to reach out and offer what shelter and sustenance we can. Where there is hope of recovery, however slight, we must be sure to offer that hope. And where there is none, we must make it plain that there is still much that can be done to offer comfort and support for as long as it will be needed.
And in doing this well, however painful the message can be both to give and, more particularly, to receive, by showing that we can and will always try to prepare the way, it is possible to take some pride in being an effective harbinger.
Monday, September 24, 2007
Party Time!
It had all but escaped my notice, but will come as no surprise to regular readers. This blog is now officially terrible.
It has all the hallmarks, namely; frequent tantrums, regular spouting of meaningless drivel, and an unhealthy fascination with bodily functions. In fact it is just like any other two year old. Sadly though, it is not very likely that it will begin to develop signs of increasing maturity as it moves relentlessly from blog-toddlerhood to blog-kindergartendom.
It has been a fun couple of years on the whole, notwithstanding the attempts of Radio 4 to mess with my mind. I’ve met some lovely bloggy people (in a virtual sense that is) who are far saner and more mature than I can aspire to be, and they and this oeuvre have kept me as close to sane as I am ever likely to approach, so to all my many and varied therapists a big thank you is in order.
Sadly it’s too young for my favourite cake (a “bootlegger cake” made with tons of nuts, a modicum of rum, and a bourbon glaze for those who are interested) so I’ll just have to look after that for it myself, but there are party hats and hooters aplenty, and lots of crisps and e-number laden dainties to ensure another year of hyperactive misadventure for any who care to join in.
Oh, and a ball pool for us all to romp in, so don’t be shy, come and join the party!
It has all the hallmarks, namely; frequent tantrums, regular spouting of meaningless drivel, and an unhealthy fascination with bodily functions. In fact it is just like any other two year old. Sadly though, it is not very likely that it will begin to develop signs of increasing maturity as it moves relentlessly from blog-toddlerhood to blog-kindergartendom.
It has been a fun couple of years on the whole, notwithstanding the attempts of Radio 4 to mess with my mind. I’ve met some lovely bloggy people (in a virtual sense that is) who are far saner and more mature than I can aspire to be, and they and this oeuvre have kept me as close to sane as I am ever likely to approach, so to all my many and varied therapists a big thank you is in order.
Sadly it’s too young for my favourite cake (a “bootlegger cake” made with tons of nuts, a modicum of rum, and a bourbon glaze for those who are interested) so I’ll just have to look after that for it myself, but there are party hats and hooters aplenty, and lots of crisps and e-number laden dainties to ensure another year of hyperactive misadventure for any who care to join in.
Oh, and a ball pool for us all to romp in, so don’t be shy, come and join the party!
Tuesday, September 18, 2007
Family Practice, a vignette.
Enter in procession Lilly (and teddy in pushchair), Elizabeth (mummy), Freddy (in pram, with attendant whirry jangly spidery mobile thingy) and, riding trail, Nigel (daddy).
The wagons circle and come to a halt in front of the desk. I half expect an influx of the whooping, bareback riding, arrow shooting Sioux Nation, all painted for war and sporting streaming feather bonnets.
Sadly this is not Blazing Saddles and no Sioux arrive. Neither does the revennant divine Madeleine Khan. Disappointed I slog on with the consultation(s).
On this occasion we have a family affair with both Nigel and Elizabeth requiring attention. Lilly spends her time lining up the trucks and passing daddy all the teddies in the room, one at a time whilst he tries to look masculine under a rising tide of faux fur. Freddie lies there, whirring and jangling in a miasma of frequent heroic farts a prop forward would own with some pride, to Elizabeth’s evident and rising embarrassment.
The consultation(s) ended, we begin the process of restoring teddies and trucks to their rightful places, and guiding the fartmobile through a series of complicated manoeuvres that would tax an HGV driver to the utmost. In a few short minutes (well ten to fifteen) the whole family is ready for the road, and off they go, as the sound of galloping palomino stallions draws ever closer.
The wagons circle and come to a halt in front of the desk. I half expect an influx of the whooping, bareback riding, arrow shooting Sioux Nation, all painted for war and sporting streaming feather bonnets.
Sadly this is not Blazing Saddles and no Sioux arrive. Neither does the revennant divine Madeleine Khan. Disappointed I slog on with the consultation(s).
On this occasion we have a family affair with both Nigel and Elizabeth requiring attention. Lilly spends her time lining up the trucks and passing daddy all the teddies in the room, one at a time whilst he tries to look masculine under a rising tide of faux fur. Freddie lies there, whirring and jangling in a miasma of frequent heroic farts a prop forward would own with some pride, to Elizabeth’s evident and rising embarrassment.
The consultation(s) ended, we begin the process of restoring teddies and trucks to their rightful places, and guiding the fartmobile through a series of complicated manoeuvres that would tax an HGV driver to the utmost. In a few short minutes (well ten to fifteen) the whole family is ready for the road, and off they go, as the sound of galloping palomino stallions draws ever closer.
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