More cutting

I wonder why it has taken me so long to write again. Things haven't been particularly busy apart from my readmissions audit. Ah, no, I was on nights. Funny how you forget that.

Leave Tom partly in the lurch and come up to theatre and do three appendicectomies in a row. Two of the patients are anxious young women, which is perfect; unlikey to be appendicitis in all truth, perfectly preserved anatomy and the opportunity to learn in a situation where you can't really go without an operation but aren't surprised when there's nothing there. There isn't, of course.

The chap is a different matter, with anm awful matted appendix, friable, screaming to fall apart and a caecum which staunchly refuses to be delivered through the incision. Alex takes over, crimps the stump and ligates it, then worries about the mesoappendix. It makes life a lot easier, this odd twist.

I'm sitting here wondering if it right that I should practice my skills on people like this. But then I think if I don't, what hope in years to come?

Primum Non Nocere. I'll have to think hard about that.

Stabbed

The particular chap has been stabbed repeatedly in the back by one of his school mates. Mostly I'm disgusted by the cowardice that leads to back wounds; but I'm intrigued by one element of the management, executed spot-perfect because the on call locum registar that evening is a cardio-thoracic staff grade.

He orders not one but three X rays. The first, normal. The second that night, normal. The third, the morning after, and reviewed by a consultant radiologist (his protocol, not ours) shows the pneumothorax.

Sometimes these investigations aren't quite as pointless as they seem.