photos!

St. Malo algae covered rocks
Originally uploaded by cirrus29.rm.

...am meant to be preparing a case presentation and a teaching session on Neonatal Tachycardia. However, cannot help looking through my holiday photos! (taken on digital compact camera - you will soon see why) We cycled more than 200km through Brittany/Normandy in the space of 4 days (21st to 25th June). I was meant to be having a week of deskbound days ("supernumerary" where you have to do all the Discharge Summaries that nobody else has had time to complete) but have been made to cover the shifts of those who are taking their clinical exams! So have done 2 long days and have to cover the postnatal ward tomorrow.

China

Watched a fascinating documentary about China's women on BBC2 yesterday evening. As it was produced for a British audience, it probably contained its biases, however the landscapes (both rural and urban) and people were mostly allowed to speak for themselves, and they gave a pretty moving account.

I've never been to China (HK doesn't really count, particularly as I haven't been since 1997), and after seeing the documentary, I'm not sure I really want to. At least not rural China. It would just be too strange to see families who, 4 or 5 generations ago, would have been indistinguishable from my great great-grandparents' families but who now live in a complete time warp. Oh, and also in abject poverty. I don't know how I would react if confronted by a real Chinese villager in the flesh. I wouldn't understand what they were saying, for a start.

Would the villager, if she understood what a fortunate beneficiary of cleverly timed emigration (and shrewd and enterprising recent ancestors) I was, and also if she knew I was a doctor, feel that I had some kind of obligation to my ancestral village? (that is, if it existed - according to some of my relatives on my father's side of the family, everyone either left or starved to death)
I, on the other hand, would feel quite impotent in the face of their many problems, and almost ashamed of my comparatively luxurious lifestyle. Would I even be able to photograph the village in the same way I photograph Hackney?

'it was busy' is an understatement

completed 7 long days on the Unit. We started the week with 9 ventilated babies. We withdrew care on one on saturday and one died on Monday afternoon. By Wednesday, we had a new admission (25 weeker with necrotising enterocolitis who was operated on as an emergency) and yesterday a 23-weeker was born.

one of the more stable babies had a cardiac arrest on saturday. This coincided with the registrar being busy with a recently discharged baby who had been brought into A&E collapsed and me being on the labour ward at an emergency caesarian section. so the nurses got the surgical and transport teams instead. anyway, said baby was down for 45 minutes, had 4 lots of adrenaline, and now has fits.

the only baby who has got any better is a 27 weeker who I weaned the ventilation on over the weekend as the registrar was occupied with the sicker ones. by the time the baby was accidentally extubated while having a chest xray on Monday, I had got her on to SIMV (see mechanical ventilation link 2 entries down) at a lowish rate and had stopped morphine. She's coped well on CPAP and even had some time off on Thursday. It was nice to be able to say to her parents that she was doing well.

Hackney in pictures (or what I did on Tuesday)

More here Colour pictures shot with Jessops SHR 200 (expired 2004), black and white pictures with Fuji Neopan 400CN. Camera: Canon EOS 3000 35-80mm. Minimal manipulation (cropping and levels only) with Adobe Photoshop CS 2.

Yay! It's Monday!

Monday mornings don't come sweeter than when you've worked 4 nights in a row and are let off early from the morning ward round! And someone even thanks you for your hard work! Bit sad, that last comment, but I think one of the problems with hospital medicine is that the work of junior doctors is largely unrecognised. I was up all night with one of the sickest babies (baby from last entry, who died on Friday) yet the thank-you card was addressed solely to the consultant, and the parents don't even know who I am. Instead, on Friday morning, exhausted and hungry from a crazy shift, I was critisised by the consultant for taking blood (from a different baby) from a heelprick instead of a venepuncture (a very trivial point that made no difference to baby). Such is the level of appreciation for my work. Still, I think it was a good set of nights overall (I never thought I would reach the point of saying this, as I am normally ready to shoot myself ten minutes into the second shift).

In short, I have finally got to grips with my job:
1. I can now confidently make small decisions in intensive care, such as weaning or increasing ventilation (and the use and monitoring of the various modes of ventilation available), the use of inotropes in hypotension, correcting pH and electrolyte disturbances etc etc
Here is a taste of the mechanics of ventilation. Note that this site is about Adult ventilation, which is quite different (both in terms of numbers, such as the rates and pressures used, and in the underlying pathophysiology), but it gives some idea of the complexity.
2. I've figured out how to organise all the routine tasks (bleeding all the patients and writing the 24 hourly summary on each - it helps that I now understand what I am writing!) so that there is time to sleep for an hour on the shift (provided the labour ward bleep doesnt go off! I was lucky on 3 of 4 nights) Also helps that I can do things more quickly, like dry off a newborn baby (they are wetter and slipperier than you think!), examine it, wrap it up and hand it to its parents, and write in its notes, all in under 8 minutes (obviously that's the ones that turn out not to need resuscitation).
3. I've learned how to get on the good side of most of the nurses and midwives (though there are a couple who are impossible, and those ones I have learned to avoid)

So life on Nights has become bearable.