Sunday, 16 May 2010

An education

I was clearing out the spare room this weekend and came across the paediatrics textbook I used over thirty years ago. One of the consultants was a bit of a character, and I made a note of a few of his sayings inside the book. Since I cannot find his obituary on I think he must still be alive, which is a cheering thought. I thought you might appreciate this flavour of medical education three decades ago. We were well aware that his tongue was frequently in his cheek.
  • (To a baby.) You know the rules, you can't wee on consultants.
  • No baby is allowed to die without antibiotics, christening and cortisone.
  • (Of drug companies offering sponsorship.) I suppose if you're very poor you have to take anybody's money, but otherwise you ought to be able to tell them to f*** off.
  • Seeing this is enough to make Matron's knickers fall down. And when that happens, all you can say is “get them on”.
  • Babies and women. Do you think they're human?
  • Do try only to kill people on purpose.
  • How many times do you make bad mistakes? Several every day? I only hope that when I'm nobbled I'm in the right and not in the wrong.
  • Don't you think you've had enough for one day? It's my drinking hour.
 Ah, those were the days!

Wednesday, 12 May 2010

A plan

Today I was asked to see one of my patients by a Government official who had just interviewed her. The message was that she was “suicidal, and had a plan”.

Now I am all in favour of Government officials being given training in dealing with potentially suicidal people. And it is true that if someone tells you that they have thought out how they are going to kill themselves then you need to take that very seriously, particularly if they have already taken steps to put their plan into action. But I suspect that “having a plan” will soon enter the popular consciousness as being an integral part of feeling suicidal. Just as all flu is now “man flu” (in men, at least) and all vomiting is projectile, so suicidal feeling will be totally unimpressive without a plan in tow.

“Projectile” vomiting used to be a term applied by doctors only to young babies with pyloric stenosis. In this condition the baby will drink a bottle of milk happily (nay ravenously) but then project the milk an astoundingly long way across the room, in the manner of Regan in The Exorcist. That is what a doctor means by “projectile vomiting”. But over many years parents have been trained by keen young paediatricians asking them whether their baby's vomiting was projectile, so that now there is a general understanding that doctors are interested in the projectility of vomit. Since patients so often want to please their doctors they will proudly announce that their vomiting is projectile. And let's face it, you're a bit of a wimp if it isn't.

A long time ago I worked for a commercial out-of-hours service and spent many happy antisocial hours driving around the less salubrious areas of town seeing a series of snotty children and coughing adults. Or occasionally the other way around. When the call details were passed through a very high proportion of the patients were said to have “difficulty in breathing”, but when I arrived their respiration was almost always normal, or at least unlaboured. The reason was that the call handlers always asked the stock question “do you/they have difficulty in breathing?” The customers, perhaps thinking that a doctor would be impressed by such difficulty and might turn up earlier, or fearing that he might not turn up without it, would answer “yes”. This has entered the local folk memory, and even now patients will report difficulty in breathing as a way of seeking my favour.

So I rang my patient who said she was fine, that the official had misunderstood, and she was perfectly happy. Just then her friend grabbed the phone and said “no she's not, she's suicidal”. “No, I'm fine” came a voice in the background. It reminded me of the “bring out your dead scene” in Monty Python and the Holy Grail. (“I'm not dead, I'm getting better!”) I was not convinced that my patient wished to die immediately, particularly when she discussed some of her (non-suicidal) plans for the future, and I made some practical suggestions to give her some hope that things might improve. Which, ultimately, is all you can do for people who see no future for themselves.