Failing Today

1. Keep my flat tidy for longer than it is not tidy
2. Organise my wardrobe
3. Pay off my last bank loan
4. Try and save £8000
5. Eat well
6. Plan my meals
7. Plan my life better
8. Do Wiifit 5 times per week
9. Read more books
10. Listen to music outside of my car
11. Plan my art project (even if I don’t finish it)
12. Take more photos
13. Be creative
14. Write
15. Be inspired
16. Be happy

And also, I’m going to try and stop being anxious…

I am taking an exam on Weds and Thurs and after that I have plans for more than just a personal site…

This post is about death and the mortuary, there aren’t any graphic descriptions, but I’m just warning you!

I had an interesting conversation with one of the guys who works at the mortuary recently.

Firstly I guess I have to go back over why I went to the mortuary in the first place.

People die whilst they are in hospital. Obviously, this does not make me happy. I ultimately decided on a career in medicine because of ‘wanting to help people’ – this is a quotation as it is the most used phrase when medical students are asked why they wanted to study medicine in the first place. On a side note, I really cannot put into words why I wanted to be a medical doctor, but I know it’s the only thing I could see myself doing. People dying in hospital though, does not always make me sad. Sometimes this is simply a failing of the balance between pathophysiology and medicine; and sometimes it is through lack of treatment either intentional or accidental.

When people die whether admitted to hospital or not, a death certificate needs to be issued. I have written many death certificates in the last (almost) 3 years. It is quite a simple undertaking at the start – name, age, date of death, place of death, date last seen alive by you etc… then obviously the cause of death. This is divided such

1. a. Cause of death
1. b. Leading to 1a
1. c. Leading to 1b

2. Disease or factors contributing to death but not directly related to cause.

A common example would be

1. a. Pneumonia
1. b.
1. c.

2. Dementia

ie the patient had dementia, which probably related to the fact that they were not a candidate to ITU treatment or resuscitation but it was the pneumonia that actually killed them.

You also need to declare if you have seen the body after death or another medical practitioner has. Now it has happened on very few occasions that I have been the doctor to both confirm a patient’s death and issue the certificate. After this sometimes a cremation form needs to completed. In some, both doctors and not, this is seen as controversial as the doctor gets paid for completing this form.

A cremation form is actually a very important two part document. It includes the information from the death certificate as well as details of the patient’s death and the part you played in their care. Once the first part is completed, a second doctor, not involved in the patient’s care, reviews the form and the notes ensuring that they are happy with everything. Once this has happened, the body can be cremated. This is pretty obvious why this has to be done as there will no longer be any evidence.

If you complete a cremation form, you need to see the body after death. Hence, why I went to the mortuary. I had just issued two death certificates (we had a horrible period just after Christmas) and was going to view the bodies. I do not know what the legal requirement is if the person is to be buried and not cremated, but I think it is good practice to view all not just those being cremated.

I see these visits as important for a number of reasons
1) check it’s the right person
2) check that there is nothing suspicious about their death (big haematoma on head, knife out of chest etc)
3) check they do not have a pacemaker (these can reportedly blow up on incineration)

Basically you have a look and feel there chest and tummy. I don’t wear gloves for this, my feeling is I touched them without gloves when they were alive so I don’t see a difference, some people disagree.

Back to the initial story. Whilst there the ‘mortuary guy’ (I feel bad for not knowing his name, but that’s how hospitals work, he doesn’t know my name… ’slightly overtalkative doctor’ maybe) was talking about keeping the skin moist for when viewings occur. In my ’slightly overtalkative’ ways I asked if there were many viewings. His response was something along the lines of ‘more than there should be’ and that he thinks it may be more down to curiosity than saying goodbye.

This made me think about my thoughts if I was on the non professional side of the situation. Having never had a close relative die I haven’t really had to think about this. I know what death looks like and I unfortunately, as part of my work, have to know what bodies look like. But, I do not want to associate any of my relatives with that. Therefore, I don’t think I would ever go to a viewing.

I apologise if some of the above sounded insensitive but I have had to desensitise myself to a degree which on ocassion does make me sad.

———-
The title comes from ’slang’ used by health care professionals. Rose Cottage refers to death or the mortuary.

Jen has tagged me following a rather extensive and informative list of 25 cardiology points, which actually I knew.. go go gadget brain. Also revision works!

Apparently you are meant to list 25 things abut yourself, habits, goals etc. But instead I thought I’d list 25 things that happened to a junior doctor today… which is me by the way!

Rules: Once you’ve been tagged, you are supposed to write a note with 25 random things, facts, habits, or goals about you. At the end, choose 25 people to be tagged.

1. I woke up twice overnight with drenching night sweats. No I do not have TB, lymphoma or thyrotoxicosis but simply a nasty viral infection. My boyfriend says it’s mild flu and blames me entirely for not having my flu jab.
2. I had Special K Red Berries for breakfast, with the poor man’s Lemsip
3. It took me 19 minutes to get to work today.
4. I arrived on the Medical Assessment Unit at 9 (ish) am and changed from my comedy boots into ballet flats.
5. I started my ward round at 9:15am
6. One of my favourite patients asked me how I was, I did not say I felt rubbish, because I did not want to worry them. They have dementia and ask me if I’m ok everyday. Sometimes before I’ve managed to ask them. I managed to stop them drinking from the hot tap.
7. The first patient’s capillary glucose measurements were running high so I increased their insulin
8. Another patient has started drinking. This makes me happy. It may only be small amounts of milk but at least it’s a start. But they probably are starting to get *another* hospital acquired pneumonia
9. I have a patient who I hope makes a century. I heard their voice for the first time today. It made me happy, before they just mouthed things to me
10. Sent a patient home with an exacerbation of COPD, probably non-infective, but the consultant had started antibiotics yesterday so who am I to quibble?
11. I don’t like antibiotics
12. Maybe I shouldn’t have started them in that pneumonia patient… ?
13. I have three favourite patients. They are all old men with dementia. One is on a different ward now, so isn’t mine anymore
14. That may have sounded very specific. It isn’t. I have many old patients with dementia. And I love them all
15. I want to be a geriatrician with a special interest in falls and dementia
16. I am obviously into cutting edge intervention and diagnostics
17. I stopped a patient’s lisinopril as their creatinine had gone off
18. I took blood from one patient and organised them a Doppler
19. They earned themselves warfarin… hello massive femoral DVT
20. I started feeling faint and unwell
21. Saw a patient mismanaged by A&E. Collapse with loss of consciousness, positive urine dipstick and postural drop does not equal trimethoprim and home. It equals at least some electrolytes, a Holter, a CXR considering the left sided creps and temp of 38.7, maybe an echo with the barn door left ventricular hypertrophy on the ECG and a systolic murmur
22. Felt more faint so my Registrar (like attending) sent me home
23. Phoned Argos as my bookcase hadn’t arrived
24. Had food and an iChat
25. Revised before paracetamol and bed

See exciting isn’t it? I should’ve worked til 21:30 today, but I felt like a pile of arse.

I don’t have 25 people to tag.

Fin

I had to get up late this morning as I’ve been so tired since finishing nights Monday morning and then having to get back to work for Tuesday morning!!! I’ve had this really weird sleeping pattern since.

I’ve managed to get to work on time fine. Well, I say that. Tuesday I arrived at about 9:10am, which is not completely my fault, how was I supposed to know the traffic was going to be that bad on a Tuesday morning? I think I need to make sure I’m not driving down the ‘road of a thousand schools’ at 8:50, mental note made!

Anyway, bar making it to work and managing to get through the days with minimal cups of tea* and food related items (and only one patient dying) I seem to get home and need to have an hours sleep from 7-8pm. Which is very strange as I have never been able to sleep during the day before** but then I end up awake at 1am. Very suboptimal when I have to get up for work at 7am!

I’m sure I’m getting old! When we lived in the hospital (fun – yes, 20 of us all living together, great – yes, leaving two minutes before you have to be at work, incredible, awful – hell yes, after about 8 months you really don’t want to be sleeping a floor above your patients, and a week of nights… yeah you don’t even leave the hospital!) which was my first year post qualifying we frequently we up until 2, 3, 4am and at work at 8-9am again… I’d die if I had to do that now!

Anyway, so today after waking up at 7am, 8am, 10am and finally getting out of bed at 11am I’ve managed to weigh out all the fruit for my Christmas cakes and soak it all in brandy… which has made my kitchen smell somewhere between Christmas and a tramp!

I need to nip to the supermarket for more tins and some cash and then I can get cooking! They may well be awful… but who cares! I love baking, and the fruit mixture does look delicious!

I was going to write something super interesting and medical… but today I am mostly excited about my cake ingredients. Tomorrow I shall be attempting to bake individual Christmas Cakes. I say attempt because if I follow a recipe I can bake easily. However, tomorrow I use an adapted recipe… I think it may be a little wet. I hate currants and the recipe I have doesn’t have glace cherries in it and I really don’t understand what that’s about so I’ve taken out the currants and added cherries and mixed peel! I have enough ingredients to try it again if it goes wrong though.

I hope they don’t, I love baking. And right now I really need to branch out, from cupcakes.

And when I say cupcakes, I do mean only chocolate cupcakes. But I do a variety of different icing.

And when I say icing, I do mean chocolate icing, or coloured plain icing!

I was gonna type things… I really was, I have a few home truths from a few on call and my last job… but right now I’ve just finished an on call where I saw

2 x ? DVTs
1 x COPD
1 x diarrhoea
1 x acute LVF
1 x alcohol
1 x paracetamol OD
1 x chest pain (musculoskeletal not cardiac *of course*)
1 x stroke
1 x medication induced confusion
1 x MS relapse

Which written out… really doesn’t look like much work does it? Couple that with being referred shite from A&E and having to answer questions from the juniors and it mounts up… still managed a cup of tea, hot chocolate and my bacon sarnie so not all bad.

And only one cardiac arrest and one death.

Ah, the life of an RMO.

I’m blogging, or not blogging again!

I am currently having a Buffy break.

I seem to be having a lot of those lately Be it, break from reviewing some literature, break from revising for my second attempt at MRCP Part 1 or as right now, break from the Big Clean

Big Clean. Urgh. I haven’t lived in the same place for more than a year since 2003 and the yearly move and house clean is really starting to wear thin. Granted if we’d kept the apartment cleaner in the first place it wouldn’t be so time consuming, and if we didn’t have so much crap it wouldn’t have taken so long to move (but I love my Buffy comics, My Little Ponies and various hoodies from uni societies – why get rid of them?!)

I received my rota via email last week. I don’t quite understand it… it’s weekly and very confusin but we haven’t been assigned yet, that’s for Wednesday. It also looks like we have to cross cover Neurosurgery overnight… which creates a huge collective yargh from all my neurons. Granted it’ll be the Reg taking all the referrals and doing the complicated stuff (like angios and coiling) but I’ve only ever referred to Neurosurgery before (which, I might point out, takes FOREVER) I haven’t ever looked after the post op patients or anything like that.

Nimlodipine and dexamethasone… that’s about my knowledge of Neurosurg, still steep learning curves are the way ahead in medicine… aren’t they??? Please say they are…

When I worked in A&E I referred a patient to the local Neurosurgical centre and it was one of my favourite A&E experiences. When you see a patient in A&E, there’s a sheet of paper for you to clerk on that has all their details already and what the reception staff has ‘booked them in’ as – it could be chest pain, ankle injury, fit… etc. This patient’s was ‘head injury’ – the A&E staple. Though following a history and exam I thought otherwise… no signs of head injury and no memory of the events, coupled with focal neurological signs and a Glasgow Coma Scale of 14 – not good.

CT scan and primary intracerebral bleed later I was on the phone to the Neurosurgical SpR who seemed to like to discuss things with their Consultant quite a lot! They then phoned back again for more information at which point my response was ‘Well we’re just taking him into resus as his GCS is dropping… he’ll probably end up tubed’

(That was me trying to sound really cool and like I was on ER… hell, I was really cool and in Emergency… just with much fewer patients and gunshot wounds and interstaff relationships)

The patient made it to Neurosurgery and had the bleed evacuated and is having rehabilitation. It was a good story, sometimes you forget about all the things that happen in medicine that are amazing. Personally I can think of so many situations where “I should’ve done that” or “Maybe that wasn’t right” or “That definitely wasn’t right” or even crying for hours cause someone died (and I was too emotionally involved) and you forget when things go right.

That’s an important lesson. I think. Maybe I should learn it myself sometime…

I’ve decided in that kind of whacky new year’s resolution thingy to start writing again (I do remind myself that I said this earlier in the year but I feel more inspired today!)

Reasons being

I’m currently in the middle of a move

With medical training the way it is at the moment in the UK up until a few months ago I didn’t know if I had a job as of August 2008.

When I say ‘not having a job’ I mean not having a training job… there are usually plenty of non training or ‘trust grade’ jobs available.

Then I reapplied for a few jobs in the second round of applications and had an interview and subsequently was offered and accepted a job in the West Midlands area.

Yesterday I was unpacking my things in a lovely new apartment in Birmingham. I have been assigned my first year of medical training there and am starting a Neurology SHO job next Wednesday

I’m starting a new job

And figured it might be a nice way to chronicle the changes in training and my progress on my path to little old lady hood

It’s like a grown up diary

Gone are my teenage blogging days of “I like this boy” “We went out tonight” etc

Anyway I’m very tired and will write something more productive soon