We are the finite of our bodies and we are the infinite of our minds.
We are a walking anachronism.
We are the finite of our bodies and we are the infinite of our minds.
We are a walking anachronism.
It was a toughie. It took me an hour to unravel what was what, which medicines were which, what had been stopped, started, changed, what he could and couldn’t do, what he understood, what the family understood, the plans for further tests and follow-up.
Thanks to Nigel for inspiring this blog. If follows-on from yesterday’s about postural hypotension. I don’t think, in fact, I am almost certain, no patient has ever asked me this specific question, although it is a thing. It is a condition that is tricky to manage and I suspect, one which is becoming moreContinue reading “My blood pressure is too high and when I get out of bed in the morning, I almost collapse. What should I do?￼”
It is more a chaotic butterfly of cause an effect, a stochastic randomness that nudges the world in a certain direction.
Some people, let’s call them extraverts tend to let everything spill-out. I am not one of those.
This blog is a form of cognitive expiation.
Not so much, ‘When in doubt, act,’ more, ‘When in doubt, care.’
Incivility from me to you is as bad as my stabbing you with a knife, just less bloody.
The doctor calling the ambulance rationalises their actions, ‘I don’t know what will happen to their chest (NB not ‘Albert’, but his chest – a lapse into pathology and medical-speak
To me it means ‘oy vey’ and ‘there you go’.
This is the transparency I encounter when I visit patients at home, in their poorliness or vulnerability, on their death-beds, in their terminal loneliness.
For me, the difference between the two belts and their equivalents in medicine can be described as transactional and transformational care.
One patient recently attempted to resuscitate her (toy) baby when the batteries ran-out.
In today’s blog Rod tried to explain what he meant when he wanted to say something was to complicated to be summarised by the word ‘screen’
Sure, some readers will think, ‘Honestly, this isn’t nannyworld, people have some responsibility, they should use their common sense.’
Still recovering from IDLES my daughter tested positive for Covid.
You can ghost, delay, emoji respond.
Have I adapted to text or have texts adapted to me?
Makes my think of my grandfather and his dilute Dettol baths or his pronunciation of Argos
…the shape of hills, the movement of water, muscles and the eye, the mechanism of the woodpecker’s tongue, the development of the foetus, creation, innovation, perspective and momentum.
Locked in a room, when you are 90 and if you have dementia and significant physical and cognitive impairment is horrible. It is cruel and harmful. It is what our older folk have to do, whilst we, the rest are out and about, living it up.
“whistle”… Rover, where are you? Oh, he must be upstairs on the bed, that old dog.
The guest that over-stayed its welcome.
The Waltzer that doesn’t stop.
Death – tradition – Jewishness – family – education – self-consciousness
I brought-up Bob when explaining to my colleagues the meaning of ‘happy accident’ – I was being flippant although the context was not.
For the most, this was people showing-off their successes, how many older people they had saved from peril (mostly keeping them out of hospital), how many standard deviations from the mean their intervention had generated and so on.
Although doctors are being battered over the head for not enough F2F appointments, in reality, telephone reviews are much harder than seeing a person in the surgery.
Take away, facial expression, eye contact and body-language and it is far more difficult to know or understand what is going-on.
My mind has been in a Japanese meta-reality rather than on Wong Lane
‘When will I receive my Covid booster?’ Asks patient Annie, 98, unable to leave her house for the past three years.
‘We are working-our way round,’ Says the doctor.
For all they care we could go to hell, so long as they can keep going.
It’s a bit shit.
#NHS #scapegoating #primarycare @BMA #justtryingtodoourjob
I read this morning about patients waiting 11 (eleven) hours outside of A&E departments.
That doctors and nurses aren’t working hard enough, that the poor are poor from choice, and, that good things come to those who deserve it or who were born lucky.
You know the game. A cryptic clue and an unexpected answer. It came to me this evening, when I was discussing my role with colleagues. I am a hospital trained doctor who works in the community and helps older people, although sometimes young ones too. Who am I? I am a geriatrician. Although I hateContinue reading “I am long and thin by the end of the summer… Who am I?”
Occasionally the nurse in attendance might advise the paramedics or the doctors, ‘He was 100 years old, he was very unwell,’
The most significant, particularly for older people (the definition of older is anyone who is older than you) when the effects of ageing can impair balance, coordination, and reflexes.
I popped into Tesco yesterday; there was no pasta on the shelves (no petrol in the pump either).
I worry that I might not have enough time to complete all the work I have planned on Monday prior to the deadline when I will be asked to present the results of the…
The PM announced a rise in NI tax this week. I understand this is to offset some of the damage they have done to the NHS over the past decade. Fantastic. (And yes, Whitey is still on the moon).
Perhaps I’ve had too many knocks on the head.
If you watch the Robin Williams / Oliver Sacks movie/book Awakenings you will see what dopamine can and cannot do to the brain.
No, not the climate, not the uncollected bins, the zero hours, no, not the Shitty White Men travelling on purpose-built spaceships that fly over the filth and poverty of a world falling apart, all of it together.
The misdirected guided by the uninformed.
We want to be associated with the best – the best team, country, organisation.
Others don’t really care.
Some see the whole of the moon.
‘She’s probably holding something in her mouth,’ I said – since the arrival of pup, she has taken to hoarding all sorts of toys and chews in her mouth.
One of those instances that over time becomes part of how you see the world.
‘Are you some sort of Communist?’ He asked.
If their lack of safety is 10 times greater than your perception of safety, are they safe? Are you?
the back wings
Imagine being able to converse with a cat.
That’s what Nakata can do.
Older people falling is often a bad thing. The Kersh Condition and diagnostic heuristics.
Anyone who has spent much time in hospital will recognise the phenomenon of the invisible patient.
All resonating, taking me back and creating an atmosphere.
What became even funnier was the background I occasionally use of a photo I took in the winter of a cob-web.
Nothing works with Florence, distraction, diversion, joking, cajoling, all the old tropes fail. You have to accept that Florence isn’t eating and leave her alone.
We lapsed into singing The Automatic’s ‘What’s that coming over the hill, Is it a Rabbi…”
‘I’ll be along in 15 minutes.’
Interestingly, hospital can be the least-safe place for older people, with home being what most want and with far fewer hazards such as the risk of institutionalisation, over-medicalisation, polypharmacy, falls and a host of other healthcare associated ills.
I was recently involved in the care of a patient who developed a pressure ulcer. Behind this seemingly innocuous sentence lurks a whole raft of issues, concerns and aspects of modern healthcare. More surprisingly perhaps, I have spoken with several doctors who believe that pressure ulcers, their care, treatment and avoidance are not a medicalContinue reading “Pressure ulcers (bedsores) & PCHC”
I wanted to begin by discussing my recent practice FB post. I called it >very frustrating situation<. That was the best I could think at the time. What is or has been frustrating? Well, I won’t go on too much about Covid (lie). The vaccine has been rolling out over the past month. And, inContinue reading “State of frustration”
People say there are more bacteria in our gut than cells in our body; I am not sure how true this is – I don’t think I am ready to say I am faeces.
You can still hold hands if someone is wearing rubber gloves; you can still laugh or smile wearing a face mask.
A basic human right – the right to family life has been bolloxed.
People who don’t know things, asking people who know things to tell other people who don’t know things, things.
I said to him, ‘You could be a male nurse.’
He replied, ‘You mean, a nurse.’
Of the 147 initial survivors, by the time they were rescued 13 days later only 15 were still alive, the others had been murdered, cannibalised or thrown into the sea.
If I was in my last hours of life and the tunnel and the bright light were there
Often old men and women will seek human contact, particularly when feeling isolated – and when I reciprocate with my gloved hand (that they don’t appear to notice as being anomalously purple or blue) we are able to make contact, to connect.
I have become victim to the system bias of considering diagnoses and discharge destinations to be of more importance than the person I am discharging.
Heuristics are the pathways or grooves laid down in our subconscious that make us behave in a certain way; habit. Something works this way, I will do it again, and again and so long as all things are equal, I am ok. If a variable changes and I don’t notice, I can be in trouble.
I know that is so very much the essence of care – understanding the language of interaction. How to approach another, how to speak through gesture, to know what to say and what not.
And, yes, those bureaucrats, the apparatchiks who felt things were returning to normal will be once again on the back-foot and find themselves redundant, scraping the earth with their over-long arms, their Neanderthal gait giving it all away.
I come from a long line of worriers, which is apposite as the subject of this blog relates to discussions with my brother about Covid. You see, he has been a mask wearer. He also has asthma like me and the combination of worrier, asthma and the time of Covid is a toxic cocktail forContinue reading “A long line of worriers and wear a facemask?”
If this narrative has held together, my point is, we can offer just as good, if not better care, treatment and support for particularly older people in their own homes than is available through high-tech medical interventions.
Thanks Jane for allowing me to continue today’s blog; that was about the ways in which Covid has forced a change in my behaviour (likely, yours too) which in turn has led to changes in my brain. It is along the lines of the blog I wrote ages ago after reading a Stephen King bookContinue reading “Covid, my brain and the computer interface”
Serial processing; switching backwards and forwards from concentrating on Word to Outlook to Chrome uses mental energy;
I have always accepted this concept; it has taught me humility.
Out optic blind-spots continuously adapt to provide us with a seamless sense of reality, only becoming real when we reverse into a wall that we didn’t see.
Our growth, our evolution has happened unconsciously, at an intuitive, human level – we have been feeling not thinking, reacting not planning, doing what feels right rather than what we are told is right.
Imagine the harm done to those people previously ‘living well’ with dementia who for six weeks have had a dramatic reduction in visitors and day-centre attendances; even the bitter-sweet routine trips to GP surgeries or hospitals have been done away with.
‘Will my mum be recorded within the statistics?’
I haven’t been asked that yet.
All we can do in the Time of Covid is to do our best and act in good faith.
We have closed schools which has reduced transmission; we can’t close care homes.