a slap too far

...just a little aside: see what I meant (a couple of posts ago) by repeated predictions of a house price crash that never seems to materialise.

Attended my first Child Protection (CP) Case Conference on monday. It was about a girl I examined several weeks ago - we found linear bruises on her back, legs and arms as well as some old scars. This fitted with her story of being beaten by her father with various objects. I guess I can't really blog about it properly as it's meant to be confidential.

I still come away from CP medicals feeling a bit bruised (emotionally) myself, particularly the physical/emotional abuse ones involving a child and a parent. In the case that went to Conference, it was obvious that the parent had overstepped the mark, on that occasion at least. But there are numerous other cases where the child discloses being beaten but there is no physical evidence. Sometimes social workers enter the the home to find a filthy, overcrowded flat, or a depressed single parent who smells of alcohol. But more often the problem is less obvious (or indeed, there may not be a problem). The home environment looks suitable, the parents are in stable employment, and the children are doing well at school. What is then achieved by having a social worker visit the family fortnightly, forcing the parents to accept 'family support services', or even prosecuting the parents? In an intact family with evidence of adequate resources(which seems a relative rarity in these parts), do the benefits of protecting the children from suspected physical and emotional damage justify the cost of straining family relationships? Certain high profile cases mean that agencies tend now to err very far on the side of caution. While I agree completely that a high index of suspicion is required until all the relevant information is gathered, I think it is also important to back down when investigation reveals that the that child is, on the whole, well cared for. I know hitting a child in this country is illegal etc. but strong family relationships (even if a bit dysfunctional) must hold some currency.

Autumn sunshine

a blast from the (recent) past

little update on Bike - he's now fitted out with brand new tyres - kevlar-lined, no less!

Bit of an interesting baby clinic today (never thought it possible!) - trying to get a portuguese interpreter at 5pm, and seeing *Esther again. (will save my gripes/anecdotes re: interpreters for another post) Esther is an "ex-prem" - a baby who was born prematurely and (typically) spent time on the neonatal intensive care unit. She is on home oxygen, and today mom has brought the travel-sized cylinder, which sits snugly in the undercarriage of Esther's pushchair. It's been 5 months since Esther was born - she was on NICU when I was working there. She didn't stick much in my memory as she was a pretty typical admission - delivered by emergency caesarian section at 28 weeks (ie 12 weeks early) due to intrauterine growth restriction (IUGR) with reversed end-diastolic flow (i.e. very bad placental insufficiency - see link). Admittedly, my contribution to her intensive care was mainly in the form of clumsy phlebotomy at 2 a.m. She did fairly well though, and she's as big as a smallish 8 week-old (which is her corrected age - with premature babies, you count from their expected date of delivery for the first couple of years) now, and smiles and gurgles etc. It's all too easy to take it for granted though.

The IUGR 28-weeker who sticks in my mind never made it out of NICU alive. I was on call the night *Mohammed should have been born. The registrar and I were bleeped urgently to Labour Ward to attend an impending caesarian section. We had the nurses ready an incubator, while we ran over (labour ward at our hospital is stupidly located in a different building from the neonatal unit) with the 'crash bag' (a shiny green backpack containing nearly everything you'd find in the back of an ambulance but in miniature). We arrived to find an empty operating theatre. A midwife waddled up to us; "they are refusing the operation," she panted. We peered into the room - a small and extremely angry Bangladeshi man was hunched in one corner, while the obstetrician - a tall black lady with an imperious mien, was flanked by two burly and irate midwives. The man's heavily pregnant wife lay on a bed in the centre of the room. She was not in labour; they had come because she hadn't felt the baby move in 3 days. "You cannot take the baby out now," said the man, it's too early! We just want scan to see if baby is OK, then we go home." His wife murmured something in Bengali (she didn't speak English, but seemed to understand a fair bit). We retreated to the midwives' office, but it didn't sound any prettier from there. Finally the obstetrician gave up, but invited my registrar to say her piece. I thought she did rather a good job, explaining what a 28-weeker was like and what could be provided at NICU, and emphasising that the baby could die if we didn't act soon. I could see the woman's eyes light up. The man was unmoved. We left them to give them time to come to a decision. Eventually, they packed up and left. Mohammed was born by emergency caesarian section when his mother developed pre-eclampsia 2 days later. He was born in poor condition, and remained comatose and floppy despite resuscitation.

I HATE LIVING ALONE

now I know why all the little old ladies get depressed and stop eating
life is not worth living without company

in reverse order

I reckon there's enough to learn about housebuying to make a GCSE. They should knock useless subjects like Home Economics (I still ended up poisoning myself every week when I first went to uni) and Design and Technology off the curriculum in favour of something like Practical Money Management, including a Housebuying module. I mean, its just the sort of dead boring yet essential subject you shouldn't have to spend your free time educating yourself on.

So I'm pulling out of buying this flat as have discovered in retrospect that I can't actually afford it. I simply (embarrassingly) made a mistake in the maths. Not looking forward to facing a half dozen irate people (solicitors, mortgage brokers, estate agents) tomorrow (well, at least it'll be over the phone), but it wasn't my fault!! I was forced to teach myself off the internet in the space of a few months about the process of housebuying, and it's only in the last week that I've grasped the finer points and it's all started to make (admittedly partial) sense. Everyone you turn to for advice has a different thing to say, and most of these people are only interested in extracting money from you. To make things worse, completely irrational things happen in the housing market - for example, if you search Guardian Money for articles on house prices, you can find nearly identical articles on an impending price crash dating from 2002, 2004 and early 2006. Of course, all of them were wrong.

The other thing that's all backwards is that this is turning out to be completely different from how I imagined it would be. I am (mostly) happy as a doctor because it's what I'd wanted to do from the age of 11, so in that respect at least, life has turned out as I imagined - sometimes even better (more interesting and rewarding) than imagined. But (like many girls, I'm sure) I'd also imagined I would be married and starting a family by the time I'd hit the age I am now. And I imagined I would be buying a house together with someone, and it would be a happy thing, not something quite as fraught and lonely as it is turning out to be. I tapped two incomes equal to my own into an online mortgage calculator just for fun, and the amount you'd get would comfortably buy my dream home - even here in London.

I don't think of myself as someone who pines for comfort and material things, but I have (unpleasantly) surprised myself with the kinds of living conditions I am not willing to put up with (no ex-council flats, no high-rises, no low ceilings, clean tree-lined streets, near a tube etc). I guess I have turned out to have more exacting standards than I thought - but for now I can't afford them.

oh no

would you believe, I've had another puncture. I was just about to get on my bike this afternoon when I noticed the rear wheel (my freshly installed new inner tube!) was completely flat AND had a large, shiny nail sticking out of it. One more time and I'll be a qualified bike mechanic.

Bit of an eventful day today. Called the estate agent first thing in the morning to make an offer on a flat I saw for the second time yesterday evening. Then walked to a nearby primary school for my first ever clinic as School Doctor.

It was more complex than I imagined. The 3 patients were all boys of 5 or 6 years old, and accompanied by their moms.
KM age 6
referred for follow-up by previous school doctor, having been discharged from the Child Development centre in 2005. referred (separately) by the school Special Educational Needs Co-ordinator (SENCO) due to
1. short attention span and disruptive in class
2. unable to read, write, draw, count or name colours or shapes
At the end of the session, the SENCO and I both wondered if he might have ADHD.

BI age 5
referred by class teacher for
1. "pees and poohs his pants"
2. developmental delay
He was a small, slightly odd looking child, who it turned out, had as few words in Turkish as he did in English.

HF age 6
referred by class teacher for
1. disruptive behaviour in class
2. "speech problems"
"but he is capable and shows ability"
He was a bright boy with a lisp who had arrived from Nigeria not long ago.

Each of these took about an hour. While I was speaking to the SENCO afterwards, my phone rang - it was the estate agent. The sellers would take the flat off the market for 2500 pounds more than I had offered. I felt a bit swamped at that point, so said I would call him back.

15:00 Child protection medical
This was the point I discovered my bike tyre was flat. So I set out on foot, fingering my phone with indecision. How many flats is one supposed to see before one commits? What if a better one doesn't come along? What if I buy, and then one does?

I had to examine 2 siblings who had witnessed domestic violence involving a knife and the severing of fingers. They were already on the child protection register. It was the first time I had to do a medical by myself.

I'd already had a really hard day (as in, with high emotional involvment, which is the aspect of medicine I find most draining and difficult) and the worst was to come. I was late, because I had allowed ample time to cycle to the clinic, but not to walk. I needed to make a decision on this flat. I wish I could have deferred it to a day when I was doing boring things, like baby clinic. I called a few people for advice, but their phones were all on answer phone. For a moment, I felt bizarrely alone in the world. I rang the agent back and agreed to buy the flat.

can she fix it?

My bike is a bit of a joke at the best of times. With only 3 speeds (slow, very slow, and a middle speed which doesnt actually change the gear) and a metal frame and that clatters at the tiniest bump in road, it's not the meanest machine. So when I came off a curb (at the edge of London Fields) with a loud bang (at 9pm on thursday, after an evening on call), I thought nothing of it and cycled on. It seemed a particularly gruelling ride, and the hypochondriac in me started to wonder if I should perhaps register with a GP afterall, if only to get an FBC, thyroid function tests, and maybe an LDH and a Mantoux as well. Imagine my relief(!) to discover, panting from carrying the green beast up a flight of stairs, that the back tyre was almost entirely flat. I'd been amazed to that point that I'd not had a puncture before, given the number of broken bottles I've cycled over since acquiring the bike (the road to bethnal green seems perpetually lined with broken beer bottles and it's often a choice between going over the broken glass and getting run over by an oncoming bus).

So I had the cheerful task today of figuring out how to change a rear bicycle tyre - the guy at the bike shop had regarded me suspiciously when I had asked for a 26x1 3/8 inner tube and "those plastic things you pry the tyre off with" (I still don't know what they're called) and when I didn't know what kind of valves I had. "Bring the bike in if you can't manage," he'd said. It was oddly satisfying to prove I could do it without help, and having cleaned the chain as well, the bike's as good as (probably better than!) new. It did take me more than an hour though.