Monday, 26 October 2009

Fuck the BNP

I’m not usually political on this blog, but the appearance of the BNP’s Nick Griffen on Question Time and the subsequent domination of the media by this fascist’s agenda has me absolutely fuming.

I don’t pay my licence fee for fascists and their followers to come onto political shows on one of the UKs great institutions and spout their hate-filled racist drivel.

Let’s recap some of the BNP’s policies (words in italics are my own comments).

· The forced deportation of 2,000,000 people (or 1 in 30) from the UK. Let’s not forget these will be British passport holders or working here with valid visas. These people will be stripped of their assets including homes and cars on the basis of skin colour.
· Millions of other Brits “of foreign descent” will be “encouraged” to return to their “country of origin.” Exactly what form this “encouragement” will take, I can only shudder to think.

I could keep going with a whole list of thing that these evil fuckers want to do, but I won’t because this post will get too long and I think you get the point already.

And yet, we have so many people who think that the BNP should be given a voice. I had to walk out of the ICU coffee room on Friday because I was so mad with one of the consultants who thought it was right that the BNP should be on Question Time. Fellow bloggers such as The Jobbing Doctor think it’s OK for people to say stuff like “Islam is wicked,” and “There’s no such thing as a Black Englishman” on national television. People who defend the BNP’s right to hate speech seem to have no regard for the targets of the BNP’s vitriol. They have no regard for their fellow citizens, instead they prefer to stand behind the right of the racists even though the very things the racists are saying would deny rights to some of their fellow countrymen based on skin colour.

Why do people in the country find it so hard to say “No.”?

What happened to the British backbone? Why can’t we stand up to these evil people and say, “This is WRONG. You are WRONG. What you are saying is WRONG and we shall have no part of it.”?

This whole episode is deeply shaming on us as a nation and a lot of people need to take a good look at themselves and be honest about what their values really are.

Fuck the BNP.

Thinking about this is getting me angry again, so I’m going to leave you with the words of a Mr Richard Reynish whose letter was published in The Guardian on Friday.

"As Britain debates the BNP’s appearance on Question Time, it would be a good idea to learn from developments elsewhere, before it’s too late. Here in Denmark, where I have lived for 30 years, we have witnessed the systemic hijacking of a progressive and tolerant culture by the far right dressed in “respectable” sheep’s clothing. In 10 years, Denmark has been transformed into a country where racism is in the mainstream.

Free speech has protected hate speech, and opponents of censorship have consistently defended the rights of unscrupulous populists and incendiarists. When the media take this line, a very wicked circle is started: the inflammatory accusations of racists become self-fulfilling prophecies, as minorities are increasingly marginalised and excluded. Mainstream political parties, attempting to win back voters from the far right, make an endless series of concessions, attempting in vain to demonstrate understanding of the concerns of voters tempted by simple xenophobic policies. But the far right will always have a more extreme policy, and a new provocative proposal, which keeps them permanently centre stage in the media.

The “debate” about immigration – in reality a platform for populist racism – dominates politics, poisons serious dialogue an guarantees one thing: racist dominance of the media and the political agenda. "

Richard Reynish
Copenhagen, Denmark.

Wednesday, 21 October 2009

In which I embarrass myself

It was Friday and once again, our intensive care unit was overfull. We didn’t physically have enough space to accommodate all the people in the hospital who need to be on ventilators. The short-term solution for this common problem was to use the ventilators in the theatre recovery area and to nurse our patients there. This arrangement cannot last too long though as we don’t have enough nurses to properly look after the extra patients and the theatre recovery ventilators are needed for, well, for theatre recovery.

A more permanent solution is to discharge patients from the intensive care unit (ICU) to make space for the extra patients. If they are well enough, sometimes patients can go to the ward, but on Friday we really didn’t have anyone in that position. Our only option was to transfer one of our patients to another ICU in a different hospital where they did happen to have some space.
Obviously it’s unfair and unsafe for paramedics to transport these critically ill and unstable patients by themselves, so one what happens is that one of the intensive care doctors and one of the ICU nurses travel with these patients in the ambulance to look after them during the journey, and also to hand over the details of their care to the doctors and nurses in the receiving hospital.

And so it is that I find myself in the back of an ambulance taking one of our patients to another hospital.

Anyone who’s ever taken a ride in the back of an ambulance will tell you that the windows are obscured so you can’t see out. Usually I’m not susceptible to travel sickness, but this day was different. We had the heating up to stop our patient getting cold, the ambulance rocked rolled as we went round corners. I hadn’t been feeling well most of the day, I was tired from being on call the day before and hadn’t eaten very much because I had an upset belly.

It was the speed bumps that really did it for me. Andy, the nurse who was travelling with me said, “You’re being unusually quiet today, Michael.”

I looked at him, but couldn’t seem to focus properly. His features swam before my eyes and I knew then that I was going to spew.

“I feel horrific,” I mumbled. “I’m going to be sick”

He raised an eyebrow. “Really?”

I could only nod because my mouth was filling with saliva and I was holding my breath in an attempt to delay the inevitable long enough to grab a sick bowl.

“Here, take this” said Andy as he quickly pulled a cardboard sick bowl from the pile in which it was stacked.

I accepted it gratefully and promptly vomited into it.

“There he blows!” came the amused voice of the paramedic in the front seat as up came the remnant of my cornflakes and the cup of coffee that I’d had just before leaving. But it didn’t stop there, I spent the next quarter of an hour retching bile as the ambulance zoomed through the city with its blue lights on and the siren going. I hadn’t felt so miserable for ages.

I had never felt so grateful to see another hospital as I did when we pulled up outside the A&E of the receiving hospital and I was able to get out into the fresh air. Our patient was absolutely fine though and on the inter-hospital transfer paper work I wrote “Uneventful transfer” in the comments section and, of course, I made Andy promise not to breathe a word about this to anyone else in the ICU.

Sunday, 18 October 2009


During a quiet moment yesterday, I was able to make my way down to the doctor’s mess and spend 20 minutes or so with a newspaper and a cup of tea. Flicking through the pages of the a Saturday magazine, I came across an interview with hip hop star Dizzee Rascal.

Who is the biggest hero of the

“Nurses, doctors and firefighters”

After what seems like years of negative stories about the NHS, it’s nice to hear us being given some credit for once.

Friday, 16 October 2009

Now I Know

I’ve not blogged much lately because my current job is really hardcore and I haven’t had that much time and I didn’t want to spend the free time I have had blogging because it reminds me of work.

In August, when I started working in Intensive Care the lead consultant, Dr. Cullen, asked me whether or not I wanted to do Intensive Care as a future career. At the time I really had no idea, and told him as much. You see, to us anaesthetists, Intensive Care work is a bit like Marmite in that it we either love it or hate it.

I worked in ICU in my first year of anaesthetic training, but at that time, I felt I didn’t really get a feeling of whether it would be something I’d like to pursue further down the line. I felt that I didn’t know enough stuff to be really useful and I didn’t know enough to actually make a real difference to the patients that I was helping to look after.

I’m now coming to the end of my current attachment in ICU and yesterday Dr. Cullen asked me again if I would consider intensive care as a career. This time I had an answer for him – no.

There are things that I really like about working here, I like it when we’re given a rapidly deteriorating patient, and I can stop their demise and (hopefully) put them on the road towards recovery. I actually like going round the wards and being able to be useful to other doctors who are struggling to look after their ill patients. I like the fact that I can actually do the majority of medical procedures, I’ve done dozens of central lines, arterial lines, intubations, chest drains, difficult venflons etc… etc… and these things no longer hold any mystery or worry for me. I like the fact that the ICU nurses are so switched-on and the fact that there are so many of them means that they can help us doctors out more which means I get to concentrate more on actually trying to get our patients better.

ICU is no land of milk and honey though. There are lots of things I really don’t like. A while ago, I wrote about why doctors get stressed and about some of the ways they cope. I said that simply being around unwell people is uncomfortable for people who have dedicated their lives to trying to make people well. I’m finding this really true of myself. Even when everyone is totally stable and there’s not much happening, I find just being on the intensive care unit stressful. The constant beeps, the almost continual alarms of the infusion pumps, monitors and ventilators, the fact that I know that things can, and often do, go tits up at any moment, all this things conspire to put my blood pressure up.

Our patients are all teetering on the brink of death. Actually, it’s more accurate to say that they’re well past the brink and with our machines we are desperately trying to push them back ONTO the brink so they have a fighting chance of living. This means that one of our patients will frequently drop their oxygen levels or blood pressure to a dangerously low level. They often hallucinate and try to pull out the very tubes that are stopping them dying. While the nurses are very good at sorting these things out, often they’ll need help just to stop the patient from expiring and it’s me that has to go and sort these problems out. Often I feel I’m fighting a pitched battle against the very people I’m meant to be helping. I find it frustrating that I can’t talk to my patients and that they’re often on the ICU for so long with only very tiny improvements to their health each day.

And then there’s the relatives. Seeing your husband/son/mother/grandpa/sister/friend unconscious and hooked up to all our machines must feel horrible. I can’t even imagine how I’d feel if I saw my mother lying their as one of our patients, I shudder at the thought. We try our best to explain what we are doing but I find having these conversations difficult simply because I don’t know what’s going to happen to their loved one. The two commonest questions a relative asks are “Is my loved one getting better?” and “Is my loved one going to die?” And the trouble is, often I simply don’t know if they’re going to live or die and, unlike when I was a physician, often I don’t even have a handle on how likely survival or death is. The uncertainty is often really hard for relatives to understand and deal with. But what I think is even more difficult is the timescale. As I already alluded to, patients stay unconscious with only very slight changes in their condition for days or weeks. We as doctors can see the subtle changes in their inotrope requirement, ventilatory demands etc… but basically, from the outside they look exactly the same. (Actually, as time passes, ICU patients look aesthetically worse as they swell up with fluid and accumulate puncture scars from all the tubes we keep sticking into them.) While we try to explain what’s happening, the seeming lack of progress after such long periods of time is often really distressing because relatives are sort of suspended in a seemingly unending, hellish limbo. Seeing relatives upset in turn upsets me because I too want their loved one to get better quickly, but it’s rarely possible and it leaves me wishing I could do more when I just can’t.

Dealing with other doctors can be wearing as well. There’s a constant trickle of calls for little things like venflons, lumbar punctures, central lines etc…from acopic ward doctors but that stuff doesn’t really bother me. I use my discretion. I help out if the request is reasonable and I’m free and able, if they’re just taking the piss and trying to get me to do their job for them, I have no qualms about telling them where to go. No, there are two things that really get me. Firstly, some doctors seem to have the belief that every unwell person should be looked after by the intensive care team. This really isn’t the case. Sick patients often don’t need Intensive Care, but they need the ward doctors to pay close attention to their condition and give appropriate treatments and sometimes, it’s hard to get ward doctors to understand this. Secondly, there are the group of patients who have been blatantly mismanaged on the wards and then I get a call to see them and am somehow expected to perform miracles. This frustrates me no end too.

And finally, there are the times where it really does all go wrong. There’s the fast bleeps, there’s the trauma calls and there’s the cardiac arrest calls. On average, I go to two or three of these every shift (my record is eleven). These are the situations where people are literally at (or through) death’s door. Sometimes, there’s not much for me to do at these calls, but sometimes there is. Often they’re just a horrible disaster and often the patient dies, sometimes in a more painful and disgusting way than you ever thought was possible.

So all in all, I’m working hard in Intensive Care, but I’d hate to do this forever. There’s too much drama, too much stress, too much politics, and too much frustration. If I had to do this forever, I think I’d end up worrying myself into an early grave, there are far easier ways of earning a living. I don’t think it’s any coincidence that two weeks ago, I found my first grey hair.

Saturday, 3 October 2009

Not everyone is happy

Apparently the pigs are a bit miffed about being blamed for the current pandemic...