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Whistle while you work

August 30, 2012

One of the great joys of anaesthesia is that the majority of the time patients are unconscious. You hope. It is, after all, your job to make sure they can’t hear or feel anything unless they are having just a local anaesthetic, or are meant to be waking up.  Or not yet asleep. You get the drift.

And many operations can take a number of hours so the healthcare professionals can talk openly and in a relaxed fashion if they want to. What they did at the weekend. How their lovelife is going. How the wedding plans are going.  Jokes. Banter. The craic in theatre is like no other.

It very much depends on who the individuals are and how they like to work. Because everyone is working non stop, and no one forgets what the purpose of being there is, but with experience lots of operations are routine, and everyone can join in the chit chat. Whilst in training in anaesthetics you are hand held initially, which basically means you have someone senior with you nearly all of the time. This also has its advantages in that you can take it in turns to pop off for a coffee. Obviously you can’t drink or eat whilst in an operating theatre, so it is a welcome and joyous perk of anaesthetics to be able to pop out to the coffee room every few hours. Surgeons can’t do that mid-op as they would have to re-scrub up and that is a mightly pain. However they do it between patients when anesthetists are tied up taking one patient to recovery and anesthetising the next patient on the list to try to minimise theatre down time. A smooth succession of patient out patient in.

The other entertainment that was not infequent in operating theatres was music. Seemingly always the surgeon’s choice, never the anaesthetist’s or nurse’s or ODA’s. The prima donna got to choose. And some surgeon’s were prima donnas; others couldn’t have been lovelier. In general the urologists were good fun – anyone who makes their life’s work staring down men’s willies has to have a sense of humour, and the orthopaedic surgeons the builders. Often rugby players. Handy with a black and decker. Those doing neuro (brain surgery) were so patient, detailed and skilled it was awesome. But their operations go on. And on. And on.

And the music they would choose would be as diverse as them. Some loved classical or opera, others heavy metal, some a light and fluffy pop. A standard time filler would be to play games like ” Top ten tunes to operate by”(not!)  and we would all chip in with our hilarious ideas………….Under pressure,  Tears are not enough,  Help me make it through the night, You ain’t seen nothing yet, Comfortably numb, Another One Bites the Dust, Killing me softly…..

If you are going in to have an operation soon let me reassure you that there have been studies showing that surgeons are happier and less stressed when they are listening to their music. Even if it’s Metallica. So when you hear their  “For whom the bell tolls” or Iron Maiden’s “Dance of Death”  booming out as you are drifting off don’t worry – it’s a sign of a happy cutter.

Bonding just started

I am a mother of three. There’s no denying it. It’s fundamental to who I am and what I have achieved. Not alone of course. Nothing I have done I have achieved alone, but having babies was definitely a partnered activity.

Growing up I’d assumed I’d have children, in that general, non-specific sort of way. I didn’t love children or yearn for them. I used to enjoy being sent to cover the infant class in my primary school when their teacher was away. I was about nine or ten probably, in the top class (of three – there were only about seventy children in the whole school) and when Miss Oldfield didn’t turn up for whatever reason, the headmaster (who was our teacher) would ask me to go and look after them. I used to make up stories for them, featuring each of them in madcap antics. There was a lot about magic powers,  ski ing down mountains and falling on bottoms I remember. They seemed to love it – pleading with me to include them in the next chapter. It was easy and it was fun, but it didn’t make me pine to have children. Didn’t really think about it.

The thumb is the middle class dummy.

So when it did come to my time to give birth to our first born, I had no real idea how I was going to react. My mother was terrified I would get the severe post natal depression she had, whereas I was having difficulty thinking about anything beyond the actual birth itself. The birth was not straightforward. Neither had the pregnancy been, but the birth was a highly medicialised affair with concerns over my heart and the baby’s wellbeing resulting in a high forceps delivery in a room crammed with obstetricians, paediatricians, cardiologists and anaesthetists. I was just relieved he was out and alive (the baby, not the anaesthetist).

I didn’t feel that overwhelming maternal pride at the birth.. No rush of emotional bonding. The first one took me probably eight months to connect with emotionally. I saw it all as duty and responsibility and couldn’t relax and enjoy it. I couldn’t pick him out amongst the rows of newborn infants in the nursery at the hospital after he was born.  Just as well they label them or I would have been there all day wondering which was ours.

The eldest bonded with the next one straight away

I was better with the second a year later, but even so it took weeks. And then the third, perhaps the nearest to this ‘bonding’ everyone bangs on about.

But I could see my husband had an ease. A pleasure. A satisfaction when he looked at the babies. Right from the word go. Unconditional love? I presume this is what is meant by bonding.

It wasn’t that he throught he knew everything about babies, but more along the lines of “How difficult can it be? We have been doing it for millenia. It can’t be that complicated. They have fairly straightforward requirements – to eat, to sleep, to be clean and warm.”

a natural

I on the other hand saw only the gaping chasm of my lack of experience, knowledge and ability. I had concern, fear and duty. I treated him like any patient – and strove to sort out his problems by feeding, changing, washing and rocking him. It was all about reacting to his needs, nothing about just enjoying the ride.But basically for me it was a learnt emotion, not one that came automatically.

Does that make me a bad mother? Does it make me not a ‘natural’ mother? Does it bollocks. Motherhood (well parenthood, but my reference point is female) is for life and whether or not I ‘bonded’ straight away is irrelevant in the long term as far as I am concerned. We are all better at some parts of parenting than others and shouldn’t be made to feel abnormal because something doesn’t come naturally.

sweeeet

Much easier second time around – just home from hospital

When I started bonding with the first  I was already pregnant with the next one (note to self: breast feeding is not a contraceptive) and  as I became more relaxed and confident that I wasn’t going to miss some obvious medical problem in him and started looking at him simply as a baby not a potential patient, I think I started enjoying it. And it just got better and better.

The older they have become, the more I have enjoyed parenthood. In general of course. Not every moment of every day. Not when I am screaming at the top of my voice to clean that bloody room before I throw you in to the street. Or when the phone rings at 4 am and it’s the police. Or the school rings to ask you to come in. Or you come home from holiday to a noise abatement notice because your house has been party central for the week…..  It’s not all been completely joyous, but it has been, and continues to be, great.

The honeymoon era of childhood – old enough to do stuff, young enough to be happy to do it with you

Choosing anaesthetics

August 22, 2012

Wish I’d had one of these all those years ago

Choosing careers must be difficult. At least having studied medicine you kind of don’t have to think about it for a while as you are on a pre-trodden treadmill  But you do have to choose which branch of medicine to specialise in.

After my Houseman year I opted to for Anaesthetics. It is by far the best specialty. Perhaps Emergency Medicine runs a close second. Basically it is really practical, immediate, covers every type of patient and disease, includes Intensive Care and lots of  life and death  stuff. You have shedloads of individual responsibility – no need to consult with others about what you are doing, but work in a group environment so get the banter and human contact.

And it is incredibly well taught. That last one makes it fundamentally different from so many other specialties which tend to leave one to get on with it and learn by osmosis and experience. Anaesthetics on the other hand is very much direct Consultant and other seniors teaching juniors on a one to one basis. After all, you can’t risk a patient’s life by leaving them in completely untrained hands. And anaesthetics is all about life and death. Putting people to slepp, paralysing them so they can’t breathe, making their blood pressure drop. All good fun and physiological games. For a purpose of course.

I did my training back in London. I’d had my year out and loved it, but pined for the city on two counts. One is snobbery – as a London graduate I believed I would get better training in a London teaching hospital, and the other is just London itself.

And so it was I rolled up to The London Hospital in Whitechapel, the East End of London. It’s so long ago it wasn’t even Royal at that time. And I  joined the large Anaesthetics department, along with a number of other new SHOs (Senior House Officers). They say starting Anaesthetics is 99% terror and 1% boredom. And that by the time you are a Consultant it is 99% boredom and 1% terror. I disagree with the high boredom factor, but the terror part is certainly true at the beginning. But that’s where the fantastic training comes in. Plus an entire new breed of people who I had never really noticed as a medical student – the ODAs. Operating Department Assistants. I think they are now called Practitioners or some other arse wank title, but to me they are ODAs. Bloody fantastic. They are practical help in theatre, and can assist the anaesthetist, the surgeon or in recovery. They will prepare the room, lay out the drugs, clean the equipment and all that kind of stuff. Obviously as the anaesthetist you are ultimately responsible for  what happens to the patient, but it is wonderful to have someone you can trust to physically move machinery, get the ECG leads out, do lots of the basic tasks. And even more important they have usually got years of experience and can really help when you are doing stuff on your own and things don’t go quite according to plan.

A good ODA will prepare a patient in the anaesthetic room, putting them at ease and chatting whilst you are finishing off the previous patient. Not literally finishing off (fingers crossed), but taking them to recovery or whatever. They will draw up the drugs, label them and pass them to you as you need them, and pass the correct equipment at the right time. They might even put a needle in ready for the drugs to be injected.

It was routine to put a tube in to the trachea (windpipe) when operating for a long time or on the abdomen (because you need to paralyse all the muscles so the abdomen will relax and allow the surgeon easy access, but it also means paralysing the respiratory muscles) and usually it is very straightforward once you have the knack. But very occasionally it isn’t straightforward and a good ODA will be worth their weight in gold as they get you different equipment and suggest new strategies you might not have thought of if you are relatively new.  They will also go get help when they think you need it!

Anaesthetics is not dissimilar to cookery – there are a thousand different recipes for the cocktails to put you to sleep and every anaesthetist has their favourite ways of anaesthetising for certain operations. Different operations require different cocktails and different patients require different cocktails within that so there are plenty of permutations to consider. And the human is a living organ (we hope) and things change as the operation progresses. And the anaesthetist is responsible for keeping that person alive and giving the surgeon optimal operating conditions. So the patient doesn’t move when the scalpel goes in for example. Or their blood pressure doesn’t shoot up and make them bleed excessively. And they wake up without pain when the operation is over. And ideally without feeling sick too.  It’s all a balancing act – too much anaesthetic and you might not wake up, not enough and you might feel it or remember it.

And we also got to do Intensive Care too – another critical care area full of practical procedures, challenging problems and very sick people.

One of the many pluses of doing anaesthetics is you get to wear scrubs the whole time so you don’t have to worry about work clothes. The hospital supplies you with standard cotton (usually blue or green) trousers and a top. Or a dress.  I always wore trousers, even with a dress. And lovely white clogs or wellington boots. Topped off with a hat and mask and you are good to go. On the wards you might add a white coat, but basically you wander round in jim jams all day. Then throw them in the laundry basket on your way out of work. Result.

The other big plus is that other doctors are nearly always pleased and relieved to see you because you are usually only called in when they need your immediate help – getting a line in when everyone else has tried and failed, resuscitating when the shit has hit the fan, taking charge of the very very sick and unconscious patient. Oh yes, anaesthetics is one of the coolest specialties.  And I had never been cool in my entire life. Until now. And I loved it.

Jim jams for work. What’s not to love?

I always love that question. Because the answer usually stops people in their tracks.

“He was the best man at my first wedding”. Firstly, most people are somewhat embarrassed to have brought it up, they don’t know what to say in the immediate aftermath. Then they have lots of questions but don’t want to be rude. Then they get over the bit about not wanting to be rude and ask away. And no, my first husband and I didn’t have any children together.

Of course the answer is technically true, but not actually accurate as I had met him before my initial, disastrous sham of a marriage. But it brings the house down and one does like to make an impact.

In fact I met him the day after I had got off with my first-husband-to-be. I was still a student and this guy was working and had a car. I was easily impressed. And he said he wanted me to meet his friends from Uni, so we set off. The way he talked about them I assumed they were going to be a couple of mates. Blokes. But they weren’t. They were a well established couple living in a flat in Sawbridgeworth. The man who-would-become-my-husband-once -the-first-one-had-got-out-of-the-way was in his slippers having been trimming his bush in the front garden. A scene so far from my student life I found it hard to believe these people were only a year older than me. But I liked him straight away. He was bright, clever, opinionated and funny.

I had whooping cough at the time as was doing paediatrics and had caught it from one of the children on the ward. I had been vaccinated as a child but vaccinations are not always 100% for life, and so I caught  whooping cough but felt remarkably well. Just sounded absolutely incredible. I would have  the classic coughing fit and then the huge ‘Whoop’ would resonate as I struggled to draw breath in as quickly as possible after my paroxysm (technical term for the bout of coughing).

And he gave me no sympathy whatsoever. No concern. Thought it was amusing and attention seeking. Which I liked. He did go on to berate the medical profession in its entirety for not being scientists, thinking they are God’s gift and the like, but I put that down to the sour grapes of a non-medically qualified research scientist 🙂

Over the next 5 years or so we spent much of our free time as a foursome. Me with my first-husband-to-be and he with his longstanding lovely girlfriend. People used to joke that we were better suited to each other than our current partners – and we did get on really well. But I went ahead and married The Two Timing Twat, oblivious to his obvious unsuitability.

Wedding day number one. MISTAKE  but a great best man!

Even on my wedding day the best man looked after me much better than the groom. Who was more interested in the football scores. (Blackburn drew with Brighton if I remember correctly. Not happy.) Best man fed me rum and cokes and talked to guests and ensured my parents had a drink.We continued to see each other as a foursome.  Lots of holidays together. Lots of weekends together. Lots of good times together.

Until TTTT left me. And I became single again. And turned to drink trebles or champagne and eat crisps and greek yoghurt. I was devastated. But thin. And eventually started getting back in the saddle which was a journey in itself.

Then the doorbell went and apparently I opened it with nothing on but an open dressing gown and a Pimms in my hand. It was late afternoon on a Saturday and my new lodger had  arrived. It was the man-who-would-become-my-second-husband.

The rest, as they say, is history.

Matilda the Musical

August 18, 2012

Mmmmm. I am hard to please, God knows. But so are most proper critics and they all seem to have adored this “fabulous’ show. So I had high hopes this would be a new Billy Elliot or Lion King – a kids show that transcends age and blows my socks off. Sadly, it wasn’t.

I don’t like child actors as a genral rule – all that stage-school over enunciation, smiling and jazz hands make me want to punch them and the first number played to that perfectly. But it was meant to – all these kids who are spoilt and considered so precious and special by their parents -to contrast with the derision heaped upon Matilda. Who I have to say I liked very much. I thought she carried her role well. And her story telling to the librarian was wonderful – and gave us the nearest thing to emotion all evening. Her little friend Lavender was endearing too. But the rest? Nah.

We didn’t really get the connection to or between the characters that would have given this more depth and feeling. Made us care more about them. Her parents were grotesque but not funny, Miss Honey insipid but not endearing, her brother just stupid. Miss Trunchbull stole every scene. She was brilliantly played -the pantomime dame in a PE kit. Marvellous.

The set is great, -wonderful classroom, gym and swing scenes. the choreography inventive and rehearsed to within millimetres. The lyrics may be funny but often drowned out by the music, but the big tunes sadly missing. Only one real big number – the rest easily forgettable.

So for me it was impressive in its design but lost the emotion and the magic of the heart of the story. Just scraped three stars.

Miss Trunchbull in full flow. Brilliant

 

 

Post Script –  after receiving a number of negative comments for this review, I found another blog who also didn’t fall all over themselves in joy at it. So I am not the only one! http://www.theatres.tv/reviews/matilda-the-musical-review/

When I was a junior anaesthetist in the dim and distant past, there was no European Working Time Directive or any shit like that. We worked for as long as we were needed. My rota was technically a one in three, but it always works out a bit worse than that becuase you have to cover each others holiday and study leave.

So one in three means that you work every day Monday to Friday as normal – technically described as 8 hours a day but for anaesthetics morning lists usually start at 830 so you would have to be in setting up by 810. Assuming you had managed to see all your patients for today’s list last night. If not, then you’d need another hour or so to check them out before coming to theatre and preparing for your day ahead. Afternoon lists finish around 5 usually, but obviously this can vary enormously depending how things go. And you can’t just ‘clock off’ and leave your patient unattended.

After the surgeon has finished though, you can’t waltz off as you have to take the patient to recovery and wait for them to be well enough to go back to the ward before you can scoot. And then you have to go see the patients for the next day’s list. So that’s routine Monday to Friday. On top of that, for a one in three you work every third night (all night) and every third weekend. So if you were working Tuesday night you’d come in to work Tuesday morning say 730, work all day, work all evening, work all night. Hope to snatch a few hours sleep but no guarantees. Then straight to work Wednesday morning and afternoon until home time hopefully about 6 pm. Depending how busy you’d been overnight it could be OK or complete shit.

But it was the weekends that got me. You’ve worked all week (including Tuesday night), and then Friday 6pm everyone else buggers off home except for those of you on call. And you will be there working or waiting to be called to work, until Monday evening. Friday morning straight through till Monday evening, snatching sleep where you can. In crappy little on call rooms.

Saturday nights would usually be livened up with car crashes, drunken fights and emergency stuff like that which would be interesting and  challenging. At some point there would be Emergency Caesarian sections. Or epidurals if you were covering labour ward. Sunday afternoons often quiet. Desperate times in soulless hospital messes with no sky TV or DVDs or computers to while away the hours. And often I’d be studying for postgraduate exams so time would be spent poring over textbooks if not actually anaesthetising.  The anaesthetic co-ordinator would try to make sure Sunday evening/night was quiet – trying to defer cases if at all possible until the follwing day. But sometimes of course things just can’t wait.

As was the case this particular sunday night where I had had one hell of a weekend. Stabbings a go-go and lots of other operations. But I had gone to bed about 1 am. Shattered. When the co-ordinator  rang at 3 am I took a while to stir out of my coma. I was near to tears with fatigue. “No Sarah, you’ll like this one I promise you”. I had no idea what he meant but got back in my scrubs and went to theatre. To be met by the ODA (brilliant folk who help in theatre) smiling at me whilst he checked the details of the male patient lying on the trolley between us.

As it happens I remember the patient’s name as it is a diminutive for penis so I also thought it was funny. Anyway, I picked up the notes and started talking to the patient when I heard a noise. A faint buzzing sound. “What’s that noise Mark?” I asked the ODA. He choked, unable to speak and turned away.

And then I opened the notes and saw the consent form “Removal of vibrator”.

“Do you want to tell me what happened?” I asked. Apparently this was his best dildo and he was having such a good time he simply let go and then couldn’t get it back. His friend had tried too but no luck. Then a doctor in casualty had tried to no avail. So here he was, waiting for a surgeon to try.

I put him to sleep and as he drifted off he frantically asked “You will let me have it back won’t you?”

I pulled back the covers and there he was. Looking like nothing was wrong.  Lovely flat tummy.But then when you looked closely, you could see his tummy wall was vibrating as the vibrator  pushed it’s way further up the colon. The surgeon tried initially with long forceps but couldn’t get a decent grip so he ended up opening his tummy and squeezing it down and out through the anus. It was fucking enormous. At least a foot long. Even the Duracells had given up by the time it was removed.  But it stood up proud on its end -pale pink and glorious as I took him in to recovery.

The co-odinator was right. Of all the cases to have to get up for at 3 am on a Sunday, that was one I did like. It had been fun. But probably not as much fun as the guy had had who got us there.

Obviously I havem’t had any ‘work’ done. I wouldn’t look like this if I had. And no one can make me three inches taller, so I’m not likely to either. But when Natalie  made me a sandwich and accidentally got a bit of anchovy on it, the immediate trout pout it produced was surprisingly attractive. Only lasted a couple of hours though, so I’d have to have a handy anchovy lip balm to keep re-applying.

Anyway, the combination of writing about my student days and watching the Olympics closing ceremony reminded me of an episode as a student in St Pancras Hospital. It is an episode of its time and thankfully I feel sure it wouldn’t happen now. But you never know.

I was doing Plastic Surgery for 2 months and the one of the Consultants I was “attached” to was the ultimate stereotype. He was suave, sophisticated, had  chiselled cheekbones and was dripping with money. He drove an incredibly flash car, waltzed in to the wards wafting expensive aftershave in his wake. He wore bespoke, understated Savile Row suits and was neat as a pin.

I, on the other hand was in a phase of wearing cornflower blue tights and a mish mash of brightly coloured things I had bought from a market stall off the Walworth Road or the army surplus store Laurence Corner. And the white coat on top. I would like to point out that my clothes were clean and didn’t have holes in or anything, but were fairly full on. The Consultant only appeared on the wards two mornings a week. Plus he had an operating list on another day. The rest of the time he was in Private Practice.
The nurses worshipped him. Or were afraid of him. I’m not sure which. A bit of both really. They thought he was marvellous, and were more than happy to have everything just the way he liked it. They didn’t think he’d like my dress sense. Those coloured tights. The purple skirt. The black and yellow top. The pearlised blue flat doll shoes.  There was no ‘uniform’ for medical students apart from being clean and tidy. I was both. But loud as well. Their concern  just fuelled the fact that I hated everything he stood for. Pompous twat. I was completely anti private practice at the time ( although happy to use it now in my mature and mellow state).

So I continued to wear what I pleased and the days passed uneventfully. He didn’t comment on my sartorial choices. Until I changed my style and went went in wearing mens trousers, a white  shirt, a tie and my white coat. Fairly sober in comparison to how I had been dressing if I’m honest.

The plastic surgeon went ballistic. Absolutely mental. Apparently I was completely unprofessional, would never make a doctor, and he did not appreciate my insubordination. What’s more I was breaking the rules. I was to get off his wards and never come back.

And what exactly was he outraged about?

The fact I was wearing trousers. No female medical student was going to get away with that whilst he was in charge.

I left the ward and never went back when he was there. But he couldn’t stem the tide of two-tone outfits and baggy trousers that took over my wardrobe. Madness had gotten under my skin and I loved them.

Loved em. Still do. And how great to see them in the closing ceremony. National Treasures now.

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