This has been a rough week. I have worked far too many shifts, most of which have involved heated clashes and extreme differences of opinion in appropriate patient care with other professionals. It has been a week of fatigue, anger and frustration.
Fortunately I now have six days off(just part of my offduty, I worked the first four days at fifteen hours a piece of this week and next week all my shifts are at the end of the week). This would be a much more welcome piece of information if I were not broke. I am being paid well enough, I am very careful with my money and dont really go in for luxuries, I am a very practical person. So why is it my wages are lasting less and less each month? I've noticed no obvious increase in any of my bills or normal expenses. I am still managing to cover all my outgoings but it it a little troubling,
I guess this will be just another month of work and staying at home. It could be worse I guess....
Friday, 11 November 2011
Sunday, 6 November 2011
Just Business
The following is based on a conversation I was having at work the other day with a few of my medical and nursing colleagues.
We are all feeling a little disenchanted with healthcare at the moment, More and more the focus is being shifted from patient care onto costs and public ratings. If you look in the stock cupboard of any ward in my hospital, on the shelves beneath the boxes containing all the equipment we use on an hourly basis, are labels telling us how much each item has cost the hospital.
Pharmaceutical companies spend hundreds of millions researching and trialing new drugs, and if the drug works really well they pub a massive price tag on it. In some cases this prices the NHS out. We cant afford to buy drugs with high efficacy ratings. I know drug companies have to recoup their investments but once they have done that and start making a substantial profit they still dont drop the prices, so my patients are receiving treatments that whilst still largely effective are not the best on the market.
My hospital recently had a status upgrade, we are now a foundation trust, this means that we receive a slightly increased budget from the Department of Health, but more importantly we get to say how we spend our money. In a normal trust the DoH give you x amount and say you have to spend 10% on this department and 4% on this department. So this financial liberty is a great first step in ensuring we can provide better care......right? I mean we can personalise our budget so departments like sexual health can be downsized as in this area there is an unnecessary abundance of sexual health clinics, the hospital should not be required to provide another, superfluous service. Cutting off the fat should be a good thing.....RIGHT?!. Apparently not, my hospital has just spent over £320,000 on the name change, literally just adding "foundation" into its name on all the signs and headed note paper. £320,000 is how much it would cost to hire thirteen new staff nurses for a year. However clearly the name change is more important. I am sure there is some legal issue requiring the immediate name change however it just annoys me when I am struggling on a ward that has to rely in agency staff of questionable skill and training on a daily basis. Even the best agency nurse wont work at full efficiency on a ward that is not her own.
The nature of healthcare and medical progression is such that it is now possible to offer individually tailored treatments for most ailments. Something like asthma, you can now manufacture drugs in a lab based on an individual patients precise unique physiology, offering a treatment so good its almost a cure. We cant afford that, so when I get a brittle asthmatic in, a normal every day human being whos caught a cold, and she asks me if there is anything else I can do to stop her suffering(and having lungs so inflammed the body is screaming for more oxygen would be my definition of suffering) and I tell her "the salbutamol, aminophyline and magnesium are the treatments we give all our asthmatic patients, you'll be feeling better again in a few days". How can I keep a straight face knowing there are drugs out there that could have her home the next day, or even prevent the acute episode to start with, but they are too expensive for the NHS.
Most Doctors and Nurses get into the job because we want to help people(its sure as hell not for the money or the high quality of life health work provides). Unfortunately our bosses are keen to remind us a hospital is a business.
We are all feeling a little disenchanted with healthcare at the moment, More and more the focus is being shifted from patient care onto costs and public ratings. If you look in the stock cupboard of any ward in my hospital, on the shelves beneath the boxes containing all the equipment we use on an hourly basis, are labels telling us how much each item has cost the hospital.
Pharmaceutical companies spend hundreds of millions researching and trialing new drugs, and if the drug works really well they pub a massive price tag on it. In some cases this prices the NHS out. We cant afford to buy drugs with high efficacy ratings. I know drug companies have to recoup their investments but once they have done that and start making a substantial profit they still dont drop the prices, so my patients are receiving treatments that whilst still largely effective are not the best on the market.
My hospital recently had a status upgrade, we are now a foundation trust, this means that we receive a slightly increased budget from the Department of Health, but more importantly we get to say how we spend our money. In a normal trust the DoH give you x amount and say you have to spend 10% on this department and 4% on this department. So this financial liberty is a great first step in ensuring we can provide better care......right? I mean we can personalise our budget so departments like sexual health can be downsized as in this area there is an unnecessary abundance of sexual health clinics, the hospital should not be required to provide another, superfluous service. Cutting off the fat should be a good thing.....RIGHT?!. Apparently not, my hospital has just spent over £320,000 on the name change, literally just adding "foundation" into its name on all the signs and headed note paper. £320,000 is how much it would cost to hire thirteen new staff nurses for a year. However clearly the name change is more important. I am sure there is some legal issue requiring the immediate name change however it just annoys me when I am struggling on a ward that has to rely in agency staff of questionable skill and training on a daily basis. Even the best agency nurse wont work at full efficiency on a ward that is not her own.
The nature of healthcare and medical progression is such that it is now possible to offer individually tailored treatments for most ailments. Something like asthma, you can now manufacture drugs in a lab based on an individual patients precise unique physiology, offering a treatment so good its almost a cure. We cant afford that, so when I get a brittle asthmatic in, a normal every day human being whos caught a cold, and she asks me if there is anything else I can do to stop her suffering(and having lungs so inflammed the body is screaming for more oxygen would be my definition of suffering) and I tell her "the salbutamol, aminophyline and magnesium are the treatments we give all our asthmatic patients, you'll be feeling better again in a few days". How can I keep a straight face knowing there are drugs out there that could have her home the next day, or even prevent the acute episode to start with, but they are too expensive for the NHS.
Most Doctors and Nurses get into the job because we want to help people(its sure as hell not for the money or the high quality of life health work provides). Unfortunately our bosses are keen to remind us a hospital is a business.
Thursday, 28 July 2011
Energy Drinks
I was just reading a facinating case study about a patient who was admitted to an emergency department in London. The patient presented with repeated unexplained fits, he was unconscious, tachycardic(fast pulse) at 160 with an irregular rhythm. His oxygen saturations were 52% on air(should be over ninety, anything less than eighty is extremely worrying). All this paints the picture of a patient in a lot of trouble. He had a past medical history of heroin and cocaine abuse however was in a halfway house following a successful rehabilitation process. His toxin screen and drug tests all came back negative but his blood ph was extremely acidic at 6.2 (I wasnt even aware this was compatible with life).
It turns out he had drunk a mug of coffee and six cans of red bull in the space of four hours. This had taxed his heart, brain and lungs.
My sister drinks loads of energy drinks more or less constantly. I cant help but wonder what effect these drinks are having on her and where they may lead.
It turns out he had drunk a mug of coffee and six cans of red bull in the space of four hours. This had taxed his heart, brain and lungs.
My sister drinks loads of energy drinks more or less constantly. I cant help but wonder what effect these drinks are having on her and where they may lead.
Sunday, 24 July 2011
Tragedy
This comment started as my facebook status however one of my contacts(at the time very drunk) posted some incredibly inappropriate comments in reply so I felt I should move the original statement here and invite any who could present a sensible comment to do so.
Any loss of life is a tragedy however the fact Amy Winehouse is getting more media coverage than the ninety-five dead in Oslo and the twenty(potentially up to fifty) victims of that nurse in manchester suggess we have some serious priority problems in this country.
I will admit to having taken issue with Amy Winehouse in the past on the basis that anyone who has celebrity status has a responsibility as a role model. Amy influenced a new generation of teenage drunk junkies.However was she like that before she became famous? I refuse to believe anyone becomes addicted to anything willingly, some trigger usually provides the push. Her passing so young is very sad. I would not normally hazard a guess at cause of death before it has been officially released but I feel it is a safe bet that it is something drink or drug related.
On the other side of the coin, the near one hundred dead in Oslo were the victims of a randomised attack by an extremist. The victims gunned down at the youth camp made no choices that could have forseeably resulted in their deaths, they were just in the wrong place at the wrong time. As far as the bombing goes I have to admit my heart stopped when I heard a developed country had been bombed. Whilst the act was horrendous I am very glad the "terrorist" was a Norweign national and thus an internal issue. We all know the result of the last bombing on a developed western country by an eastern power.
Rebecca Leighton a twenty-seven year old nurse has been charged with deliberately contaminating bags and ampules of saline with insulin. We use saline for everything, mixing IV powders into liquids to be injected, we add drugs to bags of saline for long duration infusion and we very frequently give saline bags on their own as they are designed to quickly hydrate our patients. Where I work almost every patient has a bag of saline going up constantly. What sickens me is that all of our patients are vulnerable, they have placed their faith in us as nurses and the thought of someone abusing the trust has sent shockwaves throughout the nursing world. There are no good reasons insulin would be introduced into saline unless for immediate use. I just hope that this does not effect how safe my patients feel in my care, I work really hard to build and maintain the crucial patient-nurse trust. And once again these were victims of the actions of another.
All three cases are tragic however I do feel hundreds of innocents dying superceeds the potential suicide or accidental overdose of a girl who knew which path she was on and where it would ultimately end.
Any loss of life is a tragedy however the fact Amy Winehouse is getting more media coverage than the ninety-five dead in Oslo and the twenty(potentially up to fifty) victims of that nurse in manchester suggess we have some serious priority problems in this country.
I will admit to having taken issue with Amy Winehouse in the past on the basis that anyone who has celebrity status has a responsibility as a role model. Amy influenced a new generation of teenage drunk junkies.However was she like that before she became famous? I refuse to believe anyone becomes addicted to anything willingly, some trigger usually provides the push. Her passing so young is very sad. I would not normally hazard a guess at cause of death before it has been officially released but I feel it is a safe bet that it is something drink or drug related.
On the other side of the coin, the near one hundred dead in Oslo were the victims of a randomised attack by an extremist. The victims gunned down at the youth camp made no choices that could have forseeably resulted in their deaths, they were just in the wrong place at the wrong time. As far as the bombing goes I have to admit my heart stopped when I heard a developed country had been bombed. Whilst the act was horrendous I am very glad the "terrorist" was a Norweign national and thus an internal issue. We all know the result of the last bombing on a developed western country by an eastern power.
Rebecca Leighton a twenty-seven year old nurse has been charged with deliberately contaminating bags and ampules of saline with insulin. We use saline for everything, mixing IV powders into liquids to be injected, we add drugs to bags of saline for long duration infusion and we very frequently give saline bags on their own as they are designed to quickly hydrate our patients. Where I work almost every patient has a bag of saline going up constantly. What sickens me is that all of our patients are vulnerable, they have placed their faith in us as nurses and the thought of someone abusing the trust has sent shockwaves throughout the nursing world. There are no good reasons insulin would be introduced into saline unless for immediate use. I just hope that this does not effect how safe my patients feel in my care, I work really hard to build and maintain the crucial patient-nurse trust. And once again these were victims of the actions of another.
All three cases are tragic however I do feel hundreds of innocents dying superceeds the potential suicide or accidental overdose of a girl who knew which path she was on and where it would ultimately end.
Tuesday, 28 June 2011
New Job
As the title suggests this post was intended to be about my new job. I am now a Medical High Dependency Nurse(sort of semi-specialising in respiratory high care). I love my new job I am encouraged to think about my patients. I am now equipped with training(and the beginings of experience) that allow me to assess, analyse and intervene with highly unstable patients. This is much more my environment. The move was made largely thanks to my wifes constant nagging(I was miserable and disinclined to do anything about it) but also something Sage said that went along the lines of "ask yourself two questions, why are you miserable and is the cause likely to change" the answer to both was no so I moved.
Due to the highly sensitive nature of most of my cases at the moment I dont really feel comfortable posting about them(maybe later). Fortunately I have other material. Last night (27/06/11) a new series aired on channel four. Sirens is a dark comedy based loosely around the works of Brian Kellet(Tom Reynolds). I admit at times the combination of dry wit and blunt please the masses comedy grated on my nerves a bit however I found it very entertaining, worryingly accurate of the mind-set of most healthcare workers and carrying an interesting and important message.
Without giving too much away, three ambulance techs go through a particularly traumatic call-out, this episode follows them through the post-trauma reaction. Adrenaline had flooded their systems creating a euphoric high, they then become very restless and then they experience an adrenal crash. This is summed up in the title of the episode "Up, Horny, Down". The EMT most directly linked to the traumatic event declares he can defy his biology and control this reaction. He spends the next twenty-four hours trying not to given in to these adrenal responses. As it turns out his efforts are just another defence mechanism, allowing him to distract himself.
This hit home rather. On a day to day basis most healthcare assistants, nurses, doctors, emergency medical technicians and paramedics see and do things that the human body is instinctively progamed to avoid. Yet time after time we throw ourselves towards these situations. All healthcare professionals are more than well acquainted with the "Up, Horny, Down". In addition to this it doesnt take long for any new healthcare professional to discover their own defence mechanisms that allow them to move on following a traumatic event and deal with the adrenal response. Mostly this does involve learning how to distract yourself.
The constant exposure to this sequence of events is incredibly unhealthy and against every biological urge. We just keep dealing with it and there are surprisingly few mental health issues related to healthcare work(except the slightly higher than average alcoholism rate). I cant help wondering that long term effect this system will have on me, my wife and my friends.
Due to the highly sensitive nature of most of my cases at the moment I dont really feel comfortable posting about them(maybe later). Fortunately I have other material. Last night (27/06/11) a new series aired on channel four. Sirens is a dark comedy based loosely around the works of Brian Kellet(Tom Reynolds). I admit at times the combination of dry wit and blunt please the masses comedy grated on my nerves a bit however I found it very entertaining, worryingly accurate of the mind-set of most healthcare workers and carrying an interesting and important message.
Without giving too much away, three ambulance techs go through a particularly traumatic call-out, this episode follows them through the post-trauma reaction. Adrenaline had flooded their systems creating a euphoric high, they then become very restless and then they experience an adrenal crash. This is summed up in the title of the episode "Up, Horny, Down". The EMT most directly linked to the traumatic event declares he can defy his biology and control this reaction. He spends the next twenty-four hours trying not to given in to these adrenal responses. As it turns out his efforts are just another defence mechanism, allowing him to distract himself.
This hit home rather. On a day to day basis most healthcare assistants, nurses, doctors, emergency medical technicians and paramedics see and do things that the human body is instinctively progamed to avoid. Yet time after time we throw ourselves towards these situations. All healthcare professionals are more than well acquainted with the "Up, Horny, Down". In addition to this it doesnt take long for any new healthcare professional to discover their own defence mechanisms that allow them to move on following a traumatic event and deal with the adrenal response. Mostly this does involve learning how to distract yourself.
The constant exposure to this sequence of events is incredibly unhealthy and against every biological urge. We just keep dealing with it and there are surprisingly few mental health issues related to healthcare work(except the slightly higher than average alcoholism rate). I cant help wondering that long term effect this system will have on me, my wife and my friends.
Tuesday, 14 June 2011
Married! The Finale
So far I had gotten through the ceremony and my speech without slipping up. I was fully aware that my only three duties that day were the ceremony, the speech and the first dance.
The latter was causing me come concern. I had been receiving dance lessons in order to respectably pull off my first dance. I am not exaggerating when I say I am completely unable to dance, its never been a requirment in any training or education I have received, added to this while all my peers were informally learning to dance by going to nightclubs I always opted for a nice warm pub.
The DJ called for myself and my wife to take to the floor for our first dance. Lonestar - Amazed started and we started our.....routine. It was going perfectly and I was rather proud of myself for not placing my size fourteens on either my wifes dress or her tiny feet. We were about thirty seconds from the end of the song. I was nearly done! ....then disaster struck, the audio cut out. The DJ was terribly embarressed but promised to sort it out swiftly. At which point five of my friends sprung into action - A sound engineer, an electronics engineer, a network engineer, a functioning genius and most importantly a pub landlord who had his own mixing desk in the boot of his car. Within five minutes we were set back up. We restarted our first dance and completed it well. So I managed to get two first dances. This situation didnt bother me, everything elese was going so smoothly that this just added a little character to the evening. Myself and my wife then took our own mothers to the dance floor and everyone else joined us. Halfway through the first song one of my best men did something that really impressed me, He cut in for a dance with my mother. Good Man!
The rest of the evening passed without event, the hog roast was stunning, the DJ sang various incredible tributes to the ratpack and then did the rounds performing magic tricks. I wasnt expecting magic! The night ended with a few songs tailored for my enjoyment - Kansas, Boston, etc
All in all it was a perfect day. We got to celebrate the most important day of our lives with those we love, ate well and got to party well afterwards. We liked the hotel so much I ended up booking hte honeymoon suite for another night and spending the following day in the spa.
|The day after we set off for the lake district where we spent a week doing absolutely nothing and loving every second of it. Now we are just waiting for the official honeymoon in september......
The latter was causing me come concern. I had been receiving dance lessons in order to respectably pull off my first dance. I am not exaggerating when I say I am completely unable to dance, its never been a requirment in any training or education I have received, added to this while all my peers were informally learning to dance by going to nightclubs I always opted for a nice warm pub.
The DJ called for myself and my wife to take to the floor for our first dance. Lonestar - Amazed started and we started our.....routine. It was going perfectly and I was rather proud of myself for not placing my size fourteens on either my wifes dress or her tiny feet. We were about thirty seconds from the end of the song. I was nearly done! ....then disaster struck, the audio cut out. The DJ was terribly embarressed but promised to sort it out swiftly. At which point five of my friends sprung into action - A sound engineer, an electronics engineer, a network engineer, a functioning genius and most importantly a pub landlord who had his own mixing desk in the boot of his car. Within five minutes we were set back up. We restarted our first dance and completed it well. So I managed to get two first dances. This situation didnt bother me, everything elese was going so smoothly that this just added a little character to the evening. Myself and my wife then took our own mothers to the dance floor and everyone else joined us. Halfway through the first song one of my best men did something that really impressed me, He cut in for a dance with my mother. Good Man!
The rest of the evening passed without event, the hog roast was stunning, the DJ sang various incredible tributes to the ratpack and then did the rounds performing magic tricks. I wasnt expecting magic! The night ended with a few songs tailored for my enjoyment - Kansas, Boston, etc
All in all it was a perfect day. We got to celebrate the most important day of our lives with those we love, ate well and got to party well afterwards. We liked the hotel so much I ended up booking hte honeymoon suite for another night and spending the following day in the spa.
|The day after we set off for the lake district where we spent a week doing absolutely nothing and loving every second of it. Now we are just waiting for the official honeymoon in september......
Sunday, 12 June 2011
Married part Two
Waking up the morning of my wedding I had a bath(with bubbles) and prepared a cereal breakfast for my best man(still my guest, rules of hospitality always apply!). Unsurprisingly I had no appetite. We donned our suits and he, having trouble with his cravatte offered me assistance with mine "they are tricky buggers to put on, let me sort yours out".
Later that day, just before the ceremony I had my chat with the registrars, during which I explained that I was legally and physically fit to marry under the laws of the united kingdom. One question that amused me as all anachronisms do - "are you free born and a citizen of the United Kingdom?". Fortunately in this day and age I was not born a slave......strange question!
Shortly after this I was stood in the hall, the majority of my guests sat before me and my best men stood beside me. At this point I should stress that the temperature when leaving my house was twenty-eight degrees, that was at half past nine, it was now midday, as people piled into the small room the temperature steadily climbed to what was apparently my melting point. On occasion a guest would arrive late, the music would stop as the door opened, when realising it wasn't my bride the music restarted. After the fifth time this happened my nerves were shot. Eventually the bridal party arrived at the door, headed by our reluctant page boy.
When I caught sight of my near-wife I became breathless, as she walked towards me and stopped beside me I became aware of the registrar saying something. I still have no idea what it was, my entire universe was focused on how incredible the woman beside me looked. I know it sounds cliche and because of the cliche I thought I was equipped to deal with the situation.....I wasnt.
Before the ceremony formally started my best men took their seats and a very dear friend stood. She was shaking uncontrollably in front of seventy odd people. However her voice rang out beautifully as she delivered our chosen reading. Shakespeares sonnet 116, I know its well used but I like it and the friend delivering it has a voice of pure fragile beauty perfectly suited for this one task.
"Let me not to the marriage of true minds
Admit impediments. Love is not love
Which alters when it alteration finds,
Or bends with the remover to remove:
O no! it is an ever-fixed mark
That looks on tempests and is never shaken;
It is the star to every wandering bark,
Whose worth's unknown, although his height be taken.
Love's not Time's fool, though rosy lips and cheeks
Within his bending sickle's compass come:
Love alters not with his brief hours and weeks,
But bears it out even to the edge of doom.
If this be error and upon me proved,
I never writ, nor no man ever loved."
Admit impediments. Love is not love
Which alters when it alteration finds,
Or bends with the remover to remove:
O no! it is an ever-fixed mark
That looks on tempests and is never shaken;
It is the star to every wandering bark,
Whose worth's unknown, although his height be taken.
Love's not Time's fool, though rosy lips and cheeks
Within his bending sickle's compass come:
Love alters not with his brief hours and weeks,
But bears it out even to the edge of doom.
If this be error and upon me proved,
I never writ, nor no man ever loved."
She delivered this not just in pure, clean, crystal clear english. But also in perfect Iambic pentameter. No small feat when suffering severe stage fright.
The rest of the ceremony took place with ....minimal tears. Once it was all done we all retreated to the lawn for photos. At which point my wife told me that my cravatt was the wrong way around(thank you best man). A small point which NO-ONE else picked up on but which she is clearly never going to let me forget. A great number of photographs were taken in various places. Bubbles were used in the place of confettii as we were in the New Forest and it seems they get a bit shirty about people throwing loads of paper around. We then formed a recieving line and greeted all of our guests into the hall for the wedding breakfast(a massive lunch). My brain was struggling to keep up with the ettiquette as person after person appeared in front of me (do I know this person well enough to hug? is a handshake appropriate.....AHHHH!). After more hugs, kisses and handshakes than I care to remember we were introduced to the room as "Ladies and Gentlemen, please be upstanding for the new Mr and Mrs ******". We were then walked into the room and to our seats via the long route. Orders for the starters were taken and these incredible little plates were placed in front of us, I chose the salmon....it was a good choice. When main course food was ready we were taken up by the staff, they asked us what we wanted and collected it on a plate, and carried it with us back to our seats(I could get used to this). At this point we were all fairly well plied with wine and it was obvious in the room it was having good effect as a social lubricant. The guests then went up for food, surprisingly for both families not one person complained about the food(it was that good). After a number of speaches(my best mans going down in infamy). We exited the room and everyone was given time to relax before the reception. I took this time to investigate my room and have a shower. As it turns out my room was bigger than my house and I got a little lost inside it. The shower was much needed. I got back into my suit and found myself at the bar with a double straight GlenMorangie(my favourite whiskey).
I sedately socialised with friends and family and greated friends as they arrived for the reception.
This is a good place to end part two.
Lessons from this part - Never trust another man to dress you. Your best mans speech will almost always beat yours, In extreme times of dire need your family may behave themselves.
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