Inflammation

I wonder if it's my quakerism that means I don't bite people's heads off, or the fact that I don't bite which makes me a quaker. Whatever the causality behind the issue, it isn't always a good thing, it seems.

I'm on the wards, moaning gently about the fact that someone has bleeped me and the phone is engaged when I ring back literally three seconds later. A few moments after that, my reg's bleep goes off too. Same number. She rolls her eyes good-naturedly and I go back to my slightly ill tempered whining. No big deal in that, I think, except one midwife makes a point of it and scowls. 'Pugnacious' I note to myself, and leave it at that, though I'm a little irritated by her reaction.

Maybe five minutes later, a gentleman at the front desk pipes up. I'm scrawling in some notes about axillary tails. An interesting story there which may have to wait for another time.

"I have to say, this is the most unfriendly hospital I've ever seen. It's ridiculous."

He looks tired and grumpy. I'm wondering whether I should lend him an ear; but pugilist gets there first.

I think it's she who makes the allegation that he's being rude and hostile first. Technically, of course, he is: but then so would any person who has travelled from London only to find his daughter has gone into SROM and he's not allowed to visit 'out of hours'. I'm watching the midwife carefully. She scowls at him like she had at me, then makes some defensive comment before he has got his vent out of his system. Then I watch him - as his he gets edgier and louder to make himself heard over her crossed-arm deafness.

Another midwife stands next to pugilist, and reinforces that they don't have to take this abuse, that he's being hostile and confrontational. I'm a little puzzled as to exactly how this is supposed to help, and as if on cue, he reports back "I AM NOT!"

I stand up and smile. "Hello sir. I'm the Dr on duty today. Can I help?"

I do what any quaker (or any midwife) should do, using the only organ that matters in these situations; the humble ear. It's obvious he's cranky. He sees it too, it's bloody obvious.

"You can understand we have to be constistent - we can't have different rules for different people." He agrees softly, given that I have just agreed with him that the hospital is impossible to find in the Reading one-way system. It is! Did I not get knocked off my bike on that same interminable system when I came here for interview so long ago?

We're chatting more softly when the report comes back that his daughter is not on the ward. He looks irritated again and I look at my work to see whether it can wait a moment; it can. So I offer to help, with that vague echo at the back of the mind that helping the pushy and the irate perhaps lends itself to outrageous abuse of the system. But I do feel for this chap, so I do the courteous minimum to help him and he goes on his way.

So worried am I about Pugilist by now that I speak to the nurse in charge: she needs to be softer. I leave it at that; the bureaucracy serves less than a kind word might, so I'll let him pass that on. A droplet of human kindness? I don't know.

Colleague comes up later to inform me I had undermined them both.

On thinking about it later, I did, yes. And in all honesty, given the poor outcome their particular method was leading to, I would do it again, too: when a grave error is being made, you step in. I just wonder - as I hear later, third hand, that she was 'quaking in her boots' - whether next time she will be a little softer, a little gentler, a little kinder. And a little less angry at me.

The quaker in me is a little subdued right now. Frankly, I doubt it.

Matching the Technology

I've just had a brilliant 'oncology for non-oncologists' lecture from Dr Alice Freebairn. Lots of juicy numbers to remember, some curious facts, a lot of insightful and touching anecdote. I liked it a lot.

For instance:

4 Gray would likely kill me. But she'd happily fire 66 at my oesophagus.
We have 30k new cases of Lung Ca a year now.
Br Ca is the commonest Ca in women, but they're more likely to die of lung Ca. (The old incindence/mortality chestnut answered at last!)

But she says one sentence that will stay with me for a long time:

"I like my job, because I get do do an awful lot. But with 6 patients and the same pathology, you'll have six different treatments. My job is to match the technology with the human being sitting in front of me."

One day, hopefully, I'll have the knowledge to say the same.

Like Putty

I've just realised I love pre-clerking. I know this is a confession of the magnitude that immediately ostracizes people from civilisation, but there you are.

Today's magical finding has Peutz-Jegher's syndrome, though it doesn't twig for a moment. I'm quietly fascinated by the freckling on her buccal mucosa, but shy just clear of documenting it mentally as telangectasia. My silly reservations; as soon as she has talked about GI polyps, I know exactly what her diagnosis is, and a little skip of the myocardium when she mutters its name a second later. Hurrah!

I didn't ask her explicitly about neurology, but there isn't time for that anyway: I get the rest. Christina assures me that the facial haemangiomas have a larger incidence of intracranial extension with neurology when I go and babble excitedly later to her later. But it's obvious that she's OK from this point of view.

The patient and I natter away happily for a while and I fit my pre-clerking around our conversation. She leaves grinning, smiles happily. And as she does, I look at her delicately marbled lips, her freckled hands and find myself curiously elated that everyone I meet is so touchingly, marvellously unique.

Poking stuff

I'm surprised how different theatre etiquette feels in gynae. Perhaps this is because, unfamiliar with the new environment, I find myself a little on edge. I'm not sure.

Thankfully, Roddy is one of those characters who seems to understand the paucity of training opportunities these days, and seems willing to let me try my hand: tentatively.

First up, the 'lap' steri in the woman so morbidly obese that the allowed insufflation pressures are not enough to move her anterior abdominal wall out of the way of her bowel. He struggles for a while before calling the shot and moving over to a mini laparotomy. I'm not sure why, but the gynae people use a transverse abdominal incision - and when I think about it, Mr R-S has advocated exactly the same thing to me, saying it led to full access of the abdomen. I wfeel the need to find out about the different access techniques.

I get to do my first cystoscopy; and shamefully for such a keen photographer, I'm baffled by the wide angle on the scope, never quite getting a full view. Sigh.

The hysteroscopy and mirena insertion throws up only an interesting point about the diagnosis of DUB; which I realise I'm going to have to find out about.

Final thing, get to see some vault repairs and a vag-hyst; amazing stuff, that validates the old joke about the car mechanic.

Not quite as fast as general surgery, I would say, but more than confirms my feeling that I need to prosect for a few months to get a handle on things.

And not to get fat, of course.