Garbo Sings!

I believe this was the tagline on a movie poster from the halcyon days of Hollywood. It was felt remarkable since the famed actress was notoriously laconic, so her going one better than merely talking on screen was deemed near miraculous.

We've had a similar moment here in Ambridge this week. Greg, rather than Greta is our silent starlet. Silent, and reclusive. Greg, in all honesty, like Greta before him, "Just want(s) to be left alone!"

Yes folks Greta maintained that these were her words, rather than the terser, much mimmicked "I vant to be alone!"

Greg's problem is his desire to be left alone in a rotting mausoleum of a bungalow that remains a shrine to his dear departed mother. If it had been a Hollywood mansion or a New York pied a terre, no-one would have been at all bothered. But it's an Ambridge bungalow where the roof has leaked and the ceilings have fallen in, and his family are becoming concerned.So concerned they keep ringing us up (from a separation of some sixty miles) to insist that "something" be done.

By "something" they mean "lock him up in the asylum until he sees the error of his ways". Greg himself feels they are interfering in his chosen lifestyle to an unwarranted degree. But the debris of fallen plaster that lies strewn throughout his chosen abode rather gives the lie to this. The family are quite right. Something has got to be done. But Greg remains compos mentis enough to say IWTBLA*. So there we have it. The classic Mexican (or perhaps Swedish in this case) stand off.

In fairness the psych's wont take our referral because he is not suffering from one of the classic madnesses. The Social Workers won't either because he's neither under age nor over age, and therefore, without one of the classic madnesses, he can't possibly be vulnerable can he. And so, in the end we have been left with no option but to refer him to a, to me, entirely new service, the "Floating Support Worker".

Now I suspect it's just me, but I can't help getting a mental image of a fairy god-mother at this point. Then again maybe that's exactly what Greg needs, cos like the man says in the song,

You can't always get what you want....

*"I want to be left alone!", but you knew that didn't you.

Nick Clarke RIP

Regular readers will be aware just how indebted this blog is to BBC Radio Four. Those who are also listeners will probably alerady be aware that yesterday saw reported the death of a well known Radio Four presenter and journalist, Nick Clarke. Like me I suspect they will be feeling as though they have lost a friend today.

For those not in the know Nick was an interviewer of rare warmth and humanity. Still he was dogged in pursuit of the truth, and was often able to get more out of politicians with his polite yet insistent style than the more confrontational interviewers that are the norm nowadays. He came across as possessed of a wry sense of humour, but never cynical. Above all he was able to convey a genuine interest in whatever his interviewees had to say, and a keen sense of when to press them harder if they were not addressing the matter at hand.

When he was first diagnosed with sarcoma he and his wife began an audio diary leading up to, and following on from his amputation. This was truly compelling to listen to, and brought home with his usual brilliance the confusion of the newly "disabled". He knew after his surgery his body was different. But he also knew, and was able to convey with characteristic honesty and modesty, that he wasn't any different as a person.

Radio Four are broadcasting a memorial this afternoon at 4pm GMT. Even if you have never heard of him before, if you can get to a radio, or to the website to listen to it, I urge you to do so. Though we never met I feel very much that I too have lost a friend in Nick Clarke and my thoughts and prayers are with his family, colleagues and true friends this afternoon.

NAI

Several years ago Ruth came in in tears, little Pip in tow. The thing was, Ruth and David had not been getting on for ages, had been separated for months, and were in the opening skirmishes of a divorce. Pip had just been to Dad's for the weekend. Although more than two years old, Pip was still in pull ups most of the time. Potty training had not, after all, been high on anybodies agenda.

So on Friday night Pip had gone to visit Daddy. Daddy had pulled down the pull ups (something he had never, hitherto, been called on to do). Pip's nether parts were very red. Daddy took Pip to A&E. After a cursory examination by a locum Paediatric consultant the redness was pronounced to be a scald. Daddy said it was like this when Pip came to him, so Mummy must have done it.

Police Officers and Social Workers were dragooned in, and Mummy stood accused. By the time she attended surgery on Monday, just three days after the initial allegation, Pip's skin had a normal healthy pinkness to it and was literally as smooth as the babies bottom it was and had always been. (Well toddler's bottom by now obviously...)

Now I know I'm only an humble GP, but, in my experience, scalds of the nature alleged do not clear up in such a timeframe. And scalded kids do not permit an examination with the calm nonchalance Pip displayed on this visit. Ruth begged me to write a letter to that effect with which she might arm her lawyers, but it was no good. Dr Locum Consultant had confirmed Pip's Non-Accidental Injury, and who was I to say different.

The feuding between Ruth and David carried on over the next few years, largely acted out in alegation and counter over the care and welfare of their children, with him overfeeding them, her neglecting their hygeine.... and so on and so forth.

As of now Pip and her siblings seem to have managed to grow up quite well despite their parent's best efforts. But as for their future relationships and well being I can't help but have some doubts.

Convinced as I am that the initial allegation was entirely false, subsequent behaviour on the part of both their parents,though not physically injurious, has likely left scars far deeper than any scald would have done.

Did you know what day it was?

My old friends at Radio Four have let me down. I can no longer look to them as my principal source of information on upcoming medical issues. The thing is they have completely missed the fact that today is World COPD Day.

To be fair to them, they are not alone. It hasn't been fanfared much anywhere else either. Which is a shame.

For those not in the know COPD stands for Chronic Obstructive Pulmonary Disease. It is a mixed bag of rspiratory ailments that used to be called things like Chronic Bronchitis or Emphysema. Mostly, in the developed world, it has a strong association with smoking. It also represents the end point of a number of industrial chest dieseases and some rarer inherited disorders. Whatever the cause it leaves patients increasingly short of breath, and , if untreated, likely to progress to an early death from respiratory failure.

The real problem with it is that it's not a very sexy ailment. Many physicians view it as self inflicted because of its association with smoking. Further, hospital doctors look on COPD patients as frustrating becuase the ones they see are always pretty ill, hard to treat, and by deffinition impossible to get properly better. Those admitted to hospital tend to be pretty dependent even when "well" and during exacerbations caused by infections or severe weather, their coping mechanisms fall apart completely. This tends to mean they end up needing urgent hospital admission and then require several days (or sometimes weeks) of rehab before they can be got home. And for all the time they occupy a hospital bed they are a living reminder to the physician in charge of their care that he is not the omnipotent god-like healer he otherwise believes himself to be. And worse, they are keeping other "more deserving" patients out of that bed....

Well, here are some headline figures you all should have heard this morning.

COPD is ranked the fourth highest killer disease worldwide. Well above some of the scarier cancers and even HIV.

Current estimates put UK incidence at around 900,000.

Stopping Smoking would go a long way to reducing this incidence. (Sadly not so for the Third World where the main cause implicated is smoke from biomass fuels -- though they are the latest target market for Big Tobacco too as it happens).

Any patient with this beastly disease can be helped to feel better with simple interventions in the form of inhalers, exercise and occasionally home oxygen. Many can be improved dramatically.

I suspect the real problem with World COPD Day is that it doesn't have a ribbon, or a trendy wrist band. Perhaps it's time it did.

Anyway, enough polemic for one day. I'm off to Homebase now.

(Where our Community COPD Nurse has been freezing in the name of the cause, before you ask.)

120s

It's been a bad week inspirationwise.

It's been busy, but only with the predictable early winter "flu" and invading Dalek hordes. Nothing specially interesting. Nothing very exciting at the weekend either, excepting perhaps the attack of the killer broccoli.*

One thing did occur to me though, on Sunday in Borchester Cathedral for the remembrance service. There we all were, Guides and Scouts, Veterans, Red Cross and St John's Ambulance folk. The Army, Navy and Airforce, the great and the good, and us humble commoners. We were gathered to commemorate the fallen of two World Wars and countless other conflicts.

The last post, a single cannon blast, two minutes silence, a second cannon blast, reveille.

The bishop's sermon on remembrance and peace.

And the national anthem to close.

"Send her victorious" we all bellow with not a hint of irony.

And, in a nation still at war, we wonder why everything is so screwed up.

Then we go back out to the warmest November on record for a bit of light shopping and lunch.

Seems two minutes of sanity is all we get.


*and then the broccoli splurts boiling water out of the pan and scalds my right index figer, so I have to type this in great pain. Perhaps Mr Atkins is trying to get my attention....

FYI

Just a quick notice to share the news that the latest Paediatric Grand Rounds are up here. Thanks as ever to Shinga for the heads up. Must go now, Daleks to battle, Surgeries to do.... more anon.

Time Travel

In Borsetshire the eldritch mists have gone. Or rather, have been replaced with a blanket of knitted fog. On the drive in this morning things loomed. Lots of things. It seems I must have upset the local countryfolk somehow.

How can I tell? Well they all seem to be looming out of the fog on the wrong side of the road. Mine that is. And with visibility down to 20 yards (approx 18m for metric readers) this made for a tricksy drive all round. There were three landies, two of them pulling horseboxes, one horsebox, unattached, abandoned roadside but pointing in the wrong direction, sundry well camouflaged dog walkers ambling kamikaze style in combats(!), one bike, sundry pigeons, a plethora of street urchins in Edwardian costume, and at least one soot begrimed chimney sweep with an execrable cockney accent*.

So here's the thing, with all this mayhem on the roads, how come I managed to get in to the surgery a full fifteen minutes earlier than normal, even after the usual ten minutes delay in intended departure time as the kids played their ritual game of hunt the sports kit / homework / wossname-- oh really Dad, you know, that thingy.....

Seems that the Ambridge fog distorts the fabric of the space time continuum or opens up some kind of wormhole effect to speed the passage of the big red bus. So now here I am expecting the sudden arrival of Daleks and Cybermen in my wake. Still we should be ok. After all I am the Doctor.

Now where did I put that sonic screwdriver?

* the last two only come out in the fog to "charm" our American cousins. Them and Nannies flying their umbrellas.