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Lots of funny words in medicine – euthymia, meaning a normal, non depressed, reasonably positive mood
the right sort of mood to be in.
Its been interesting seeing what different people consider ‘normal’ personality and ‘normal’ states of mind.
I interviewed one patient, who has exceptionally detailed religious ideas, formed from a mish mash of other religions -taoism, buddism, judeochristian and new age. Interestingly when it comes to religion, it is actually a matter of how many other people that believe the same thing as you which is more or less the defining factor if your beliefs are classed as religion or psychosis.
We were given the example of a Hare Krishna, our illustrious neurologist had no idea if what he was saying was in line with Hare Krishna beliefs, but his fellow Krishna’s assured him that it was infact out of line and he was thus treated for psychois.
This seems a tremendously arbitary way of determining illness to me, I mean its probably a necessary distinction – the alternative being that all religions are delusions (which would probably make Dawkins rather chuffed) or that religion is again, out of the jurisdiction of rationality.

As an artist, sometimes I get lucky and get inspired, and its really exciting, I want to write it all down, explore it, tease out the ideas while I can still see it. I love these times. It doesn’t come all too often, sometimes it doesn’t lead anywhere good, but it’s exciting and may come up with really great things.
It’s this amazing energy, a tingliness, and you can see, feel, touch, smell connections between ideas. Just magic.
This, however, is more or less the definition of hypomania with possibly a bit of mild psychosis thrown in.

Reminds me of something John Nash (A beautiful mind) was reportedly to have said when asked how an intelligent man like him could believe such crazy things; “these ideas came to me the same way my mathematical ideas did, so I believed them”

I am not mad?

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Lillies

I have overheard some students saying that they were disappointed that there wasn’t enough death in hospital. Maybe I’m too soft and squishy right now, but I’m in no hurry whatsover to see more than what comes.

Random Violence
I observed a craniotomy .

The man’s brain was, in a word, buggered. There was a haematoma covering probably a 1/3 of his left hemisphere, obliterating his 3rd ventricle. It had lost its nice colour, the normal texture and architecture, and to top it off, there was an uncontrollable cerebral bleed. He never regained conciousness and passed away. We never found out what exactly led to these horrific injuries – other than some sort of altercation. I know it happens all the time, but its sad that someone can be beaten this badly and be left there – he was only brought in as a chance finding.

On suicide and not knowing
I had interviewed him recently. I was chastised for not delving into his deep melancholy having been distracted by his more florid pathologies though my risk assessment and management plan had been satisfactory.
I had been the last one interview him, in fact. We had gotten on well, talking about music and ultimate fighting. He was picking up, becoming happier, more reactive, interested in getting better.
But somewhere along the day, and I’ll never know why, something changed and he tried to take his own life by leaping off a building. He didn’t suceed totally, but will be severely paralysed at the very best.

I wonder what was going through his head, I feel awful for his family, for the team that has been looking after him and inevitably we all think back to when we last saw him, was there a clue there? could we have forseen this? could we have done something about it?
But mostly I just feel sad.

on dying
He’s dying. He knows this but not quite know how soon yet and the question has come whether we treat him aggressively, for little gain, or we go palliative and he can return to his country(land) and family. He thinks that aggressive treatment will get him 5-6 years. It won’t, 12 months or so at best. If the renal failure doesn’t get him, the cancer will.
So we talk, about life, his family and about dying. He’s not afraid of dying and is remarkably cheerful and graceful, and for that I’m grateful – it makes a difficult topic easier to discuss.
We’ll meet again soon after he talks with his family and he invited me cheekily to his country some 6 hours away.
I hope I can get there, I hope that I did the right thing, I hope that he chooses well, and I hope that he has a good death.


I had grand plans of frequent updates, of tales of mirth and woe as I entered my clinical years of training. Unfortunately studying is like being mauled by a bear while being simultaneously sodomised by an irate porcupine. So I haven’ t had the time to poop, let alone formulate a semi quality post. However I thought it was about time to chuck a few things up else I would be falling behind my esteemed colleagues Here, here and here.

I dont know shit. That much is obvious on a daily basis – I spend most of the time with palpatations, (the caffeine doesn’t help) trying desperately not to be revealed to be an awful fraud.
But I am grateful to be able to be present and particpate in powerful moments like births. I may be entirely superfluous to the patients medical requirements, but their generosity never cease to amaze me.

She was a grand-multi (well expecienced mum), with an uncomplicated preganancy and as I had seen her the week before in antenatal clinic, generously invited me to be present. It was all going smoothly, and baby’s head appeared on schedule. But then it turtled (Looked like it was trying to go back in) and its colour started going bad and from there I stopped breathing – the obstetrician came in and tore off the end of the bed, the paediatricians rushed in, the midwives jumped in and pushed her legs back (McRoberts). As the ostetrician pulled almightily on the baby, a midwife did some magic internal manouvers and bub was delivered – floppy, pale blueish to the waiting paediatricians. The whole thing probalby only took 4 minutes but it stretched into eternity until we heard the baby cry. Big boofhead (4.3kg) was fine, and mum was fine, and i needed a bex and a good sit down.

One of the things that stick with me is this women who I followed through a 20 hr labour, ending in a C section. The poor thing was exhausted, and there was no father present, so I got to hold her baby and take him up to nursery. For the most part, they were happy endings in obstetrics – some tense moments with more shoulder dystocias and a few emergency caesars, but mum and bub ended up well.

ANd though it’s a cliche, really childbirth is crazy, gross, beautiful, wonderful, joyous all at once – and the sight of a healthy baby and the look that the parents have for their child makes me forget that I haven’t eaten anything more substantial than a muesli bar or slept for more than 3 hrs in the last 48.

However there are some awful stories, from relatively simple and common (from our point of view, but terrible for them) miscarriages, and ones of abuse and neglect resulting in severe disability or death for the neonates.

me : So, with this ECT machine, how much current can this machine produce?
bemused looking consultant : 100%

Blackbirds

Hume Weir

Leash

We get to see amazing things – like the beautifully insufflated and illuminated pelvis during an exploratory laparoscopy.
She had amazing anatomy* you would almost expect to see Netter signed in the lower right hand corner.
Textbook, pristine.

I saw her at the shops today, and wondered where I knew her from, before realising. And I couldn’t help by cringe when she lit up a cigarette as she exited the shopping centre.

*not in this picture, I just found this for illustrative purposes

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