I am no historian. I struggle with details. Dates and times have never been my thing. I am however a reflector. I look at the world around me, absorb its colours and ponder. I was going to say ‘think’ although FEEL is probably more accurate. For once, I will not quote Bruce Lee (Google, ‘almondemotionContinue reading “Dementia, David Cameron and losing ground”
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.
‘Will my mum be recorded within the statistics?’
I haven’t been asked that yet.
Mostly, my approach is to consider that we, that is the community services (those outside the acute hospital) can and do support a far broader range of patients than people realise and, when working well together, can care for a significant proportion of the people who otherwise arrive at the door of A&E.
A new class of drugs, originally called ‘novel anticoagulants’ (NOACs) and now, that they aren’t that new, ‘direct oral anticoagulants’ aka ‘DOACs’ have overwhelmed the marketplace
In the hospitals (the hole) we sit and wait.
Eventually, inevitably, the older person will fall-in;
The NHS has a tried and tested technique; it is called hospitalisation.
Norma is going nowhere.
Five months later.
Norma’s bungalow is sitting empty. Dust gathers on the kitchen-tops.
Jemima, a little more oxygen running through her arteries, her blood-pressure moderately increased is admitted to hospital.
The example being:
89-year-old woman, lives alone, dementia, diabetes, COPD, has fallen, bruised face – best admit.
And this is the thing.
Let us be like Daleks who, to contend with Christopher Eccleston evolved to cope with stairs…
Who have slipped from, Jean in the corner, retired postmistress from Fife, to bed 12;
Cartier-Bresson’s Decisive Moment, my patients falling, examining life and projecting forwards.
It is an odd thought – dying in your sleep. Pyjamas, tooth brush, perhaps a few pages of a novel and no more. Your eyes close and at some point, in the night, heart stops. Dead. This is what it is to be alive. Precarious, a tightrope of existence or not. The mechanismContinue reading “In your sleep – (Safe in heaven, dead/)”
There is an assumption that when the lights go down and the night-staff appear on the scene that things become quiet and still – a little like a scene from Bambi.
Could you Facetime your doctor when you are on holiday in Greece rather than having to wade through the complexities of health insurance (yes, Brexiters) and a foreign health system?
Snap – your left hip.
She survived. She could have died – I never asked the question.
‘Did my dad die because someone didn’t follow policy, didn’t pay attention or, was the outcome inevitable?’ ‘Might my mum have survived the operation if she had a different surgeon or she was at a different hospital?’
You are unconscious, the focus for the doctors and nurses is maintaining your physiology with particular attention to your brain and heart.
Nevertheless, within the dark underbelly of medicine, where geriatricians live, there are some quite stunning effects often, from stopping and sometimes starting medicines.
They aren’t diseases or malfunctioning organs, they aren’t flow or machinations of the system; they are universes unto themselves and those who love them.
The concept of a ‘reassurance scan’ is particularly treacherous, for often, odd abnormalities are discovered – with such frequency in medicine that they even have their own name… ‘Incidentalomas’
We, the homeostatic organisms that have evolved over the past four billion years, exist in a state of serenity when well, but things can be thrown out of kilter by disease.
What could be better – working within science and the metaphysical, the harmonious synchronicity of mindful being and state-of-the-art clinical science?
In other words, intravenous saline although a fundamental part of modern medicine is nowhere near as good as a cup of tea.
The point, as is often the case, is my aversion to patients. Or rather, the existential construct that relates to the ‘patient state’ = they who suffer; with the principal goal of my life being to obviate suffering, my objective is to really stop people turning into patients.
And that is the role of the interceptors.
So long as you are still able to participate, join-in with the conversation, your perception of self is just as valid as that of the doctor or nurse.
How to change the system?
Here we have it, a system that needs to be changed, a system that is changing and a process that is threatening to kill that system – you might think of puberty with anabolic steroids or platform boots – wobbly, unsafe and unsightly.
Our actions at times border on the holy, and we cannot allow the profane to defile the sanctity of the experience.
And so, to my colleagues, the team of Mallard, I say, here we are – we are something special, we are the exception to the exception that allows magical things to happen.
I didn’t have to remove my shoes, thanks to new trainers.
To a box, the world is the world, is the world.
There has been a silent revolution happening…
Habits are our liberation, they are also a limitation
An old man living alone, is that the problem? Is the problem that it is a problem?
I have recently been asked to show what I do, to demonstrate, I guess, how much value I am for the money spent on me.
Alan Paton wrote Cry the Beloved Country, I sometimes cry for the beloved, the forsaken who don’t fit into our systematic boxes.
We can look at quantity of life – something we have very little influence over, or, we can address, quality – an area we can influence tremendously.
I’m sorry if this sounds a little dark, and that, is probably part of the reason most people don’t want to go-here.
I can’t imagine what modern medicine would be like without these colourful pieces of plastic.
Patients in pyjamas – it might sound a little flippant, but I think this is something that is very important. I cannot comment on the behaviours of other patients outside of the UK – we, in Britain, approach hospital attire in a special way; pyjamas. I don’t know when pyjamas began in hospital – whether backContinue reading “Patients in pyjamas”
So, I have a problem with the elderly; what do I do when I have James, a 95 year old man, with coal tattoos crisscrossing his knees from years down the pit, as he coughs and lies in bed worrying about his wife who is at home, struggling to cope herself.
How can we change a 98 year old with pneumonia into a person, how can we sketch, add layers of detail that establish the place of this person in the clinical stratosphere? How can I convey their humanity?
It is likely that a doctor, a nurse or carer admitting, ‘something is wrong, I don’t know what,’ is better than heading off down a therapeutic blind alley.
I have spent the past few days feeling bad – It is strange, when you discover that something you have been doing, that you had considered ‘right’ is explained to be wrong; it is a little like breaking the law when you don’t know something is illegal … I can’t think of an instance (or,Continue reading “Therapeutic lies and false promises…”
Here is a question… What do you do when someone you are caring for, refuses your attention? When you, the ‘carer’ – doctor, nurse, therapist, father or son are unable to find a position or a stance that makes sense to the other person, to the extent that you are viewed as a burden, anContinue reading “Locked-in, drugs & the 60’s”
Earlier today I watched a TED video by writer Andrew Solomon about his experiences with depression. It is a mesmerizing performance from someone who is both stunningly articulate and strange. Solomon describes his experiences with depression and one of the most significant moments in the piece relates to him discussing the idea that depression isContinue reading “Depression & hospitalisation”
I hate it when one of my patients falls over on the ward. Each time this happens, I feel as if I, somehow have personally failed to keep them safe, safe, when they are unwell and at their most vulnerable. It is true, that people falling in hospital is complex, it is equally true thatContinue reading “Falling over & knots”
Amongst the piles of lost-and-found that accumulate in wards, care homes, clinics and hospital laundries across the UK, surely the missing dentures, spectacles and hearing aids point to something wrong with the way care is operating. ‘I’m fine, thank you,’ smiles Mary. ‘Do you know where you are?’ No response A little louder, ‘Mary, doContinue reading “Dentures, specs & hearing aids”