Time to recharge the batteries

My car is ill.... on Friday a red light came on indicating that I had ignition problems... I managed to keep it going until Saturday morning, as the lights got dimmer and dimmer, and then managed to coast it to the local Ford dealer on Saturday who said they would look at it and get back to me, but most likely the link from alternator to engine had gone - apparently this is common in Ka's. However the Ka has also done almost 12000 miles since I got it in August (see here) and needs a serrvice.. so this little episode may not be cheap........

Ethics in psychiatry

Wow well Psych turned out to get a bit busier towards the end than I had anticipated. I ended up completing all 4 case sin the final week, and had to adapt one of them to fit the demands of the Uni ethics case.

However, like many others I worry that I have done the ethics case wrong. The guidance notes seemed to refer to patient safety stuff and us seeing staff doing things wrong and how this could affect the patients prognosis and outcome.

Mine focuses more on the issues to do with a 17yr old with prodromal posychoses and self-harm but who contninues to abuse large quantities of illicit drugs, and for whom pharmacotherpay is bcoming elss effective as he takes more drugs to achieve the high he wanted.

I linked this to teh situation of heart disease, and the fact that medics and GPS continue to give statins and anti-hypertensives een though people continue to eat badly, exercise poorly, and drink and smoke mroe. Thus I reasoned the illicit drugs were only different ebcause they were illegal, but that such isuses shuould not affect patient care.

However from the otehr side, if the pharmaco-therapy is meaning that the patient is taking more illicit drugs (with no quality control sapling etc) then it puts him at greater risk of adverse side effects and making his psychiatric condition worse, so maybe in the interest of non-malifience we should cut back his treatment.

In the end I came to no clear view........but in my experience psychiatry was all about discussing the options and not coming to a decision......

Sorry for being away

Where did February go?

Mostly in a haze of youth group stuff, psychiatry at Uni - of which more later and sleeping - for some reason I am absolutely shattered this block!

generalness

This is lining up to be a nice quiet weekend. Yesterday was a bonus day off, when my supervisors signed me off from the ObGyn block on Thursday, and since they had no clinical activity on the Friday, i decided to have a study day, and i did a bit of the pre-work for a tutorial on Monday, and did the laundry and tidied the flat.

Today is a freezing morning, and we are promised some -5 ish frosts over the weekend which will be fun, so some time today i need to top up on screen wash and de-icer to make sure I can get through the weekend in the car. Today should have a leisurely feel - some shopping, gym, about it until late afternoon, when there is rugby to be won - we can't afford to lose the first match, because with Scotland playing Wales tomorrow, an english victory today would only spur the Welsh on, knowing that they was one team less in the contest for the Grand Slam.

Postal shenanigans

I live in an area covered by the XX1-4 delivery office. I'm expecting a parcel - too big for a letter box.
I was expecting a 'card' and then I;d have to go to the local delivery office - about 10 min walk away, which is open 7.30am-5pm 3 days a week, and 7.30am-12.30pm on the other 3.

But today I got my 'sorry we missed you card' asking me to go to the XX45 Delivery office in Ned-estate. And even then it is only open 8-12 each day! Seems ridiculous.

It is on my way to hospital (kind of, but I risk being late, and I need it asap. It seems stupid that they did not try to deliver it from my local Post Office. So I need to leave 30 minutes earlier, and may get there late!

Clank clank bang bang

What a way to be woken up at 6.31 on a Monday morning. A smattering of snow on the ground, and people building a crane outside your bedroom window (and yes, I am 4 floors up. It seems that the site opposite has now reached a stage when the 'new' building inside the 'old' facade is strong enough to allow the mecanno which has been holding the facade up since August 06, is being taken down - in a very different way, and with a much smaller crane than when it went up. Also, Uni prevents me sitting watching them all day....which was a fun way to revise for the year 2 resits.

This also means that the building is almost finished, meaning my road with return to 2 lanes each direction, allowing for 'off peak' (i.e. 6pm-8am) parking outside my front door once again. This will also later this year see the office block being available for a tenant, the 'upper floors' with their glass walls towards me potentially being occupied, and the ground floor shops, and restaurants opening. Except this is a recession, and a conversion of a similar building in Edinburgh about 2003 left them waiting 5 years for a tenant - and even then they only took one floor of the building.


OOOh this is post 401.

Cases...

One of my supervisors this block has an unusual way of approaching my case reports. Hew anted them in by week 3 and then sat me down went through them and pointed out some errors, but instead of them giving me the mark, he wants them re-written and handed in by mid next week. This gives me both an opportunity to correct those problems, a second chance to worry about introducing more, and a worrying situation of having to tidy up all my cases in one weekend!

Looks like this weekend will be more book based than last weekend.

In an interesting twist, the Med School, and med School Library are shut for most of the weekend (usually we have 24hr access) as the door swipe card machine is broken. A biut annoying for e, but the 5h years are only 2 weeks from finals and are les sthan pleased to have to use main library and their own textboks.

London

Well a fun weekend in London was had, with Pete, Anna, Jack, Ronnie, Rachel and Jack all being there for part or all the times of fun.












We all started off meeting up... well this was where the fun started. The agreed time was 2pm in 'Lord Moon of the Mall' on Whitehall, or "the wetherspoons near Trafalgar Square" as it was described to me. Despite getting up earliest, traveling furthest and being 20 minutes late, I was stll the first to arrive. Well we all traipsed in one at a time over about an hour, and sat chatting and drinking a bizarre cycle of coffee, juice and drinks. About 4 we decided to take a wander down to the embankment, and along to the South Bank to see the huge book fairs under the bridges. As we walked past Trafalgar Square, we saw a protest of some sort (I suspect gaza related).
The south bank was quite good fun, and we ended up in a small pub near Blackfriars Bridge which was warm, cosy and not too noisy, despite the football on the tv. It took us a while to realise it was cup (itv) and that Car meant Cardiff, nor Carlisle.

Then we headed off, and a few of us went back to Pete's and cooked up some tasty tea. This involved passing through London Bridge, obtaining my very own Oyster Card, and then a wander through the inner east end.

On sunday a more touristy day was planned, with 30 minutes stiuck on a hot tube due to signalling problems. We alighted at Kings Cross, had some tasty lunch, and then ehaded for a wander around Bloomsbury, the british Museum, Soho, the West End, finishing in Leicester Sqaure before I jumped the tube back to Euston for the train. On the way up Oxford St, after passing through Uniqlo, I saw this fantastic shop selling walking sticks and umbrella's. It still had half closing Wednesday and didn't open on Sundays!
For higher quality pics, just click through.

SSM(C) 2

I have another SSM / SSC coming up in March-April. After the fun of my last one at big city hospital in November, I am hoping to do the next one out at DepCat hospital. This one is looking to be an ICU Audit of some sort, and there will be two students doing it. The ICU there is much smaller so hopefully elss records to rake through!

Anyway the two of us students met last night, over coffee to plan our moves from here and brainstorm some ideas on what we could audit - any sugegstions? We have to meet the Consultant, plan the audit, sort out the practicalities, submit it to faculty, get a response to faculty from the consultant and have faculty approve it. All by next Friday.

A strange week

More on London later in the week when i catch up with myself.

Monday was a day of ante natal clinic and then Gynae theatre (of which more later). After this I got a text from Butcher Boy asking if I fancied a trip to Ayr that night as he needed to go there........given my main plans at that point were an evening off, I said I was free and my car was at his convenience if he bought me a Maccy D's....so I picked him up outsode his work at 7.

The roads down to Ayr was empty. just as we rolled round the Ayr bypass, he sugegsted Pizza instead.... so after getting down and him doing what he needed to, we went to get a Pizza Hut atke away.....after not really getting lunch (or breakfast), and late night sudnay, that pizza was good.... and the irony of eating a chicken pizza whilst watching Hugh Fearnley Whittingstall going on about animal welfare was not lost on me.

Tuesday was less fun though. After getting back from my placement to the West End, I had a pre-meeting about my next SSM (more later) and then found that the rear tail-lights were not working in my car..... after a 2hr wait for the AA man (or actually his subcontractor), they don't carry bulbsm, which is what the problem turned out to be. So he put the bulb from reversing light into tail lights so I could drive it yesterday, then I made it home for 10pm for the second day in a row!

Lundun

Slight break in proceedings this week due to Uni work, and tomorrow I'm away for the weekend.... to see friends in London.

Simple pleasure

Friday night: after Uni and stuff, a quiet pint or two in the pub with a few workmates from the past (G star, Butcher Boy and Little Miss P amongst others), chatting, joking and generally relaxing. The pub so quiet that we have to move from upstairs to downstairs as they are sending staff home early and shutting upstairs at 10pm.

Saturday morning : fresh cooked bacon in an oven cooked roll with brown sauce. Behind me the washing machine rumbles away on the third load of the day.

Perfect.

Shame that left the car in the West End, I need it tomorrow and its currently throwing it down and blowing a large gale.

Traveling, traveling, traveling far.....

The hospital where I am doing my Obs/Gyn is about 25 miles away from home. And has 3 main roads into the town. All 3 currently have roadworks, meaning that it can take 30 minutes, or 45 minutes to get to the hospital in the morning. The antenatal clinics are about another 10-15 miles beyond the hospital, which makes getting there lots of fun as well. There is a bus, but it takes 1hour plus a 25 minute walk. May as well just resign myself to a 320 mile weekly commute!

Straightforward cases and ethics!

I'm finding Obs/Gyn a strange block - Obstetrics seems to be a mix of sonography, surgery, medicine, and being a referral service for Midwives. A lot of the consultant work involves initial assessment by sonographer / midwife and then just a quick consultation by SpR / Consultant. This makes trying to talk to people for long enough to get a case study quite difficult.

One day I spent time on the Maternity suite / labour wards, initially shadowing my consultant, but later the Spr & Fy2 who seemed to be doing most of the work. There was less of the competition and agro between Midwives and Medical staff than i had been lead to believe existed, and also less resentment to my presence as a Medical student.

Two cases filled a large part of our day - a young woman who had a C Section and also had HELLP which meant her blood wasn't clotting correctly. She developed a haematoma under the would and was taken back to theatre to have it removed. As they undid the staples, there was a strange sound, and a plume of blood sprayed towards me as I jumped backwards to escape the pool of red arterial blood on the floor. The clot was removed, and the bleeding vessels were sealed. It was an interesting case, because she was at that moment receiving lost of blood products and transfusions, and the situation had fairly rapidly escalated from a post op patient who was a bit sick, to a surgical emergency. Interesting to see, but not very mentally taxing.

The second case left me thinking for a long time about ethics and my opinions. Itw as a patient who had gotten pregnant despite a contraceptive implant, and then decided to have a medical termination. The implant secrete progesterone (which IIRC both 'prevents' implantation to stop a pregnancy, but once one has started, maintains the placenta). The Medical termination pills cause blocking of progesterone receptors, causing the placenta to die and the uterine contents to be delivered following further medicine administration a couple of days later.

In this case the patient had passed the foetus into the vagina, and the placenta was coming out. My consultant used a speculum to open the vagina and said, "Look in there. see the hand and face...." I was quite unprepared for that to be what I saw. Medical termination sounds very sanitised and clean. The actuality is less nice, and quite traumatic on the mother.

This has contributed to a growing ethical dilemma for me over the issues of terminations and abortions, which I may explore in a future post once I get time to read more on the subject.

What is it?

Sadly this rather nice looking spacecraft/firework / whatever is actually some kind of rocket or missile or bomb over Gaza. I don't know which way it is going, or who will be the victims of it, but it occasionally amazes me how something so pretty can be so lethal.

edit: The BBC website now captions it as "Israeli artillery shells explode over the Gaza Strip"

The day the earth stood still

My annual cinema visit was tonight...well I think it was last January when I last went to the cinema. I think we (that is me, little miss P and another of my former work colleagues) meant to go to a mind emptying joke fest (e.g. Bride Wars) or action film, but ended up at a thought provoking version of the Al Gore film....It's a good film, about an alien race who come to earth in 'globular balls' which look something like the planet earth...they have come to save the other species then destroy the humans to allow the planet to recover 'Earth is one of 5 planets in the cosmos suitable for supporting life, we cannot allow you to destroy it'.

The film however ends on a cliffhanger, with none of the 'modern' mechanical or electronic items on earth (from a watch upwards) working. The product placement for Microsoft vista also gets quite annoying, though the touchscreen desk looks quite fun. Mind Keanu Reeves is starting to look quite old........Speed was quite a few years ago....

Thought provoking.

I was listening to Radio 4's PM programme in the car on the way home today and they were talking about Leona Lewis writing her autobiography at the age of 23. they interviewed the author and commentator Matthew Parris, who made the interesting point that maybe we should all write down our views (not feelings) on the world, because we forgetso quickly what we once thought or accepted as normal.

He gave the example of how few of us can remember what we thought when 18, and whilst sat at traffic lights, I pondered on this. I know a lot of teenagers around 16-20, but I can't say that i can think like them anymore, or even visualise their hopes and dreams.

And when I think back to when I was 18, way back in 1999-2000, it is tinged with the actuality of what happened. The dreams of studying medicine and the reality of doing a Biology degreee, the dreams of what I could/would do, and with whom, and the reality which was so different.

It was not just the hopes, dreams, and opportunities that I had, but also the changes to me, to life, and to the world which I could not have forseen which have changed my thinking, changed the world and changed my life since that point - the friendships, relationships, deaths, opportunities, disappointments and such like.

Maybe this is a good frame of mind to start my bnext block, OBstetrics and Gynaecology, one half at least of which is about the hopes, dreams and opportunities , and a child who can be anything it wants to be..........oir it could be like the 'child' today jailed for culpible homicide at the high court, of whom the Judge said:

I accept that the very early years of your life, prior to your adoption, were emotionally traumatic; having been born in Corntonvale Prison to mother then addicted to heroin and a father who had himself died in police custody. He had apparently been physically abusive to you even although you must have been little more than a baby. It is hard to image a more deprived and tragic start to life.

However, it is equally clear that your adoptive parents tried very hard to compensate
for that early start by providing you with a comfortable lifestyle and the potential for a good education and future life.

Whatever the psychological reasons for it, you spurned their attempts to help you
and engaged in a life of substance, drug and alcohol abuse and, ultimately, crime.
This lifestyle culminated in the death of another young man at the start of his adult
life.

What must the views and opinions fo this young teenager be, and how alien to most of society must their thoughts be to do this, and yet, their hopes and dreams may be very similar to many other people - a partner, family, money, job, house.......I guess we can only hope that prison rehabilitates.

Do cashpoints get hungry?

Today a Clydesdale cash point ate my debit card because, according to my bank (HBOS) 'card services' department "The bank which operates that cashpoint was worried about the security of that cashpoint and to avoid a potential fraud it closed down and retained your card"

Ok.....except
1. Why not close the cashpoint before I started my transaction?
2. If there is a skimming device (and I didn't see anything which looked like one) why allow me to put the card in and enter my PIN before shutting down?

These are points I may be raising with HBOS and Clydesdale by letter. For once I even had sufficient funds in my account!

The cashpoint was in a Clydesdale bank wall..... thankfully my bank is now open Saturday's a mile away so I went there to get it sorted over the phone. still takes 7 days for a new card to come (odd given that Play.com can manage next day delivery), but they were able to give me cash based on photo ID and my having a credit card with the same bank.

Happy New Year!

As introductions to 2009 goes, I felt almost Gazanian... the fireworks from City Chambers appeared to be shelling my flat, and indeed on the TV pictures it looks like they were. I managed to be outside from half eleveen and was still frozen when I got back home, and yet sweating and needing Beechams... I think my Chjristmas Cold has returned.

As tonights headlining artistes finish on the main stage outside, I am watching QI under a duvet and waiting for the noise to finish so I can sleep. If this is what 2009 is like, I'm not entirely sure I liek it.

I am however looking forward to tomorrow, and if I had any similarly mad friends (and did not have a cold) I'd be up for doing the Loony Dook at South Queensferry! Havings aid that, I have no plans for tomorrow, and may end up just heading out to wander round the quiet of the city.

2008/9

Well 2009 is now a little over 6 hours away and in common with my general state this year I made no plans for tonight and now end up with no actual evening as such. Most of my friends are quite apathetic for new year this year, with a large focus on 'staying in'; 'doing nothing'; 'got no money'; and 'meh'; when I surveyed them.

I have the car so could go to one of the gatherings I know are happening, but that involves going all the way down in Newcastle, or Reading, both of which are a long way. and would cost lots of patrol. I have my House series 3 from Christmas, a warm flat, lots of tea and wine, and a huge pile of ironing, so it could be that I have an interesting evening, unless I get a better offer by text soon. I also have a large street party and concert outside, which if I open the window I can hear perfectly, and should I want to, I could go to with the 2 free 'inconvenience' tickets I get from the organisers.

Looking ahead, 2009 should be a good year:- my last holiday as a student, elective, and SSM, my Child Health block and for the first time in (at least) 12 years......a summer with no exams!

Looking back 2008 was a year of some highs (passing 3rd year, my ICU SSM, my block at seaside hospital - including chicken sewing and fireworks, passing driving test, getting a Car, my Sister's wedding) and lows (death of close friends, death of grandfather).

I liked 2008, it was a good year, but I am looking forward to 2009 so much more.

Random photos

I was in the West End of Glasgow yesterday and took some unusual pictures......

Icicles!

It was quite cold yesterday!

Any ideas?

Does anyone know what this thing on top of a post box is for?

Ann On A Mouse

Faculty have sent out an email this week reminding us of the need to remove all identifying patient information from case reports when we hand them in. They have then requested that we do not use initials either.

This causes minor issues in referring to the cases with educational supervisors, and also with supervisors checking the patient details to ensure that we have got the interpretation of investigations correct.

It would also seem to me that 3 blocks into the year is maybe a little late to tell us!

Busy weeks

The past fortnight have been quite manic so far and seem to have one ongoing pattern...in fact most of this ICU block has focussed around dying. It is a common thing, given that 33% of all ICU admissions die in ICU and 50% before leaving hospital. Also this month has been the one where I had to write a Palliative Care case, and work on a Palliative Care plan for the patient.

As you will have seen from past blog posts, the perceived unfairness of who dies has been something I have been thinking about a fair bit.

Also mixed in with all this has been a variety of random non-Uni stuff, tech for a CMF conference weekend away (where end of life issues, euthenasia, and assisted suicide was one of the main discussion topics - some interesting views and opinions); Origin events in Princes St Gardens - where I kept warm by handing out flyers and shaking an orange bucket; and in St Cuthberts in Edinburgh last weekeend. Then this Monday I was at the launch of a CD recorded at a concert we did in the sumemr, and on Friday is another gig, in Grangemouth. So I''m so looking forward to Saturday for a long lie!

A change of scene

With one thing and another, I haven't really been home in daylight since well....October, and noticed this morning that the new 'roof extension' to the building opposite seems to be well underway with structural floors and supports in place and the outer skin being put in place. This is to be covered in glass apparently.

Continuing the cheery theme....

The new Barnado's campaign is on TV and cinema's. It is hard watching, and a telling reflectiuon on an aspect of society today... for a media obsessed at the moment ith child rape, child murder and hoodies, knives and teenage gangs, what about looking at teh root causes. Are the former linked to the latter. What is cause, and what is effect......

Should we get annoyed?

a.k.a. Why do good things happen to bad people.

Over the past few weeks, a common pattern seems to be emerging - often young, previously healthy patients with wives/husbands, young families, and who are working and contributing to society* are getting very sick, and or dying, whilst chronic alcoholic, IVDU's end up recovering from their alcoholic encephalopathy, seizures, and coronary events*.

*the above are composites of different patients.

It seems unfair that people who were doing good, and are only a little older than myself are dying, despoite all the treatment we can offer, and yet people who are on their second or third ICU visit are recovering, but not reforming and going back out to continue their downward spiral.

I am not suggesting that some lives are more important than others, but there does seem a fundermental unfairness about the fact that those who contribute to society are the ones to die, and those who sponge/take from socety are the ones who survive.

As one doctor put it today "those with a rough paper-round have just become so tough that it takes more than a bit of alcohol and an MI to kill them".

Sorry

Sorry about the lack of posts recently, but I seem to be really tired after my SSM days, which is worrying as I now have to work on the essay etc!

Skills....

This has been a week of firsts.....................

• My first pleuritic tap...maybe next time my hand won't shake so much..... and the patient will have less excess soft tissue so I can feel the top of the rib - the tap needle must go along the top of the rib not the bottom because the neuro-vascular bundle runs along the bottom of the rib.
• My first 12 lead ECG which I managed to set up, record and then have a go at analysing myself....though I did need some leading through it. ECG's are one of my bogey areas.
• My first Arterial blood gases (sterile procedures) and blood cultures.
• My first dead body in a mortuary...technically it is my second, since I saw a PM during my BSc Honours year in 2004, but this was the first where I had known /met the patient.

Many of the patients this week seem to be either very, very sick, or alternatively just bobbing along getting better slowly...more to follow later.

Snow!

This past weekend was the DIME weekend away, again in Aviemore, and it snowed!

Fireworks!

Down at seaside hospital last week, we attended the fireworks at the local sports area, in aid of the local hospice - £4 to get in... here are the best of my pictures.

Belt up!

I've waited a wee while to post this, so as to avoid anyone reading this, then the paper and thinking "ahhhhh".

At seaside hospital we were encouraged to be on the receiving surgical team, and accompany them between teaching sessions, clerking patients in, examining them, taking bloods etc. This was quite good fun, though could be very slow depending on what turned up.

One Friday night, at the end of another quite long week - pub quiz, many cases to write up and lots of tutorials, Irish Hunter, with whom I had been at DepCat Hell Hospital, and I decided we fancied some A&E action....or laughing at drunks as he termed it. So one Friday night, after some food we headed down to A&E. At first it was quite quiet, with only a few early drinkers in having fallen (it was freezing) after a few too many (it was near payday). The first patient was Irish and had a scalp wound which was bleeding like crazy, so while Irish Hunter tried to get enough blood from his cold arms to fill the tubes (and try to do so in the right order), i as set to work suturing his wound, after the middle grade had injected some nice local anaesthetic. It was quite tricky as his head was lolling all over, and the needle was hidden under the blood, and it was the first tie I had done it, except on the chicken....

Anyway, he was patched up and sent round to the observation ward for the night. We wre just commenting on how quiet it was and why weren;t more drunks alling over, when the ambulance radio squarjked into life

"XXX to Seaside Hospital, Over"

"Seaside Hospital Casulaty receiving, over"

"We are inbound with a [young adult] male, RTA, unrestrained driver, with no obvious broken bones, but a sore neck and no feeling in the legs. He is not bleeding and has minor bruising and scratches to face and arms. ETA 15 minutes"

"Received. Can you give GCS? over"

"GCS 15, Over"

With this, everyone sprung into actions, Orthopaedics were paged, and everyone went into the resus room. Over the next 15 minutes, the consultants ran through the importance of ATLS assessment with us, and indicated roles which we could assist with at various stages, depending on the various scenarios. When teh patient arrived, he was on a spinal board and had dirt and grazes on his face and arms, but no bleeding or obvious wounds. However, as we ran through the ABCDE, it became clear that D was his mahjor issue. He had altered sensation below the nipples and no sensation below the waist.

A trauma series of Xrays (neck, chest and pelvis) was ordered and when these came back, they showed a strange shape to his spine at the chest level. Since he was otherwise fairly stable, with oxygen and fluids, he was transferred round to the CT scanner where teh duty radiologist and radiographer were both present.

The CT of his neck was unremarkable except for a congeital malformation at C1, but when his chest CT came through, there was a gasp from the consultants, who were nearest the monitor, as it became clear that he had a complete dislocation of two of his vertebrae, with a movement o about 3 inches laterally, and complete transection of his spinal cord.

The neuroscience institute were consulted and so on.....but as we came to leave at 1am, the consultant said, "remember guys, wear a seatbelt....." And as we stood in the car park, waiting for the car to warm up and scraping ice off the windscreen before the drive back home, we were reflecting on how different life would be if people did things slightly differently - split second timings etc......

weekends

Wow, what a weekend! Today is Monday, so it's Ayr......having driven rather a lot in the past 3 days, and also spent a fair ammount of time working doing techy things like building amp lands and running 9with others) approx 10km of cables in a room smaller than a tennis court, running 5 events in 2 venues, across 27 hours, and getting 12 hours sleep.

It was stressful, enjoyable, tiring, exhilerating, long, fun, heavy, work but the results were great ad everyone seemed pleased. There were no losses of temper, no shouting and only a bit of blood and tears, but plenty of sweat.

However, i dented the Ka and also cannot find my glasses. I was wearing contcats when the former happened so the 2 events are not connected!

interesting ethical issues

I've been percolating on this one for a week or so now, but want to share it with you all because I need some other opinion.

In a session on peri-operative care, one of the consultants said that it was no longer 'normal practice' to order a chest Xray prior to an operation. Previously, JHO's and Fy1's had always ordered one for the anaesthetist. However, since the Surgeon didn't need it, and the anaesthetist usually didn't need it, the reports attached to the Xray were not read, and on occasion, small tumours etc were missed, which were later investigated and the Radiologist report read "the mass seen on dd/mm/yyyy has enlarged". The family got upset that no one had read the report of the original mass, and sued the NHS.

The consultant then went on to say that we should also never order blood tests that we did not need for the current management of the patient, because if we found an adverse result we would have to act on it.

I guess this comes down to 2 main questions:
a) should NHS hospitals be screening people for common ailments just because they have been admitted with a different condition.
b) if a hospital finds an adverse result and commences management as an in-patient, does the hospital pay instead of the PCT.......

Some patients do seem to fall through. we saw a lady with gallstones who had an irregularly irregular pulse. to us Med students that indicates AF. Yet despite having her pulse taken every 4hours, no one had noted the rhythm/character or done an ECG (she was admitted via GP not via A&E). She was due an operation at the tail end of last week, so it will be interesting to see if she received an ECG / cardiology referral, or if the anaesthetist was the first to notice in theatre! If so, might it be the downside of the assertion that investigations should not be carried out unless necessary. no-one thought it necessary, and they have to deal with the result.

Similarly, we saw a patient on an orthopaedic ward who had a BP of 180/100mmHg, despite being on triple therapy for Hypertension (Angiotensin 2 receptor antagonist, Calcium channel blocker and ACE inhibitor), and despite an inpatient stay of 2 weeks, had not had a review done by anyone from the Medical side of the hospital.

Conversely some departments are very good. Especially those with links. Vascular wards are quite good for getting cardiology to come and check out patients who display any cardiac signs - many get ambulatory ECG or 24hr recording monitoring to establish the nature of any cardiac complaint. But again vascular and cardiology are very closely linked physiologically and pathologically.

Art I like!

This is the new sculpture in T5 and Heathrow. Sadly it is only on the luxury levels, but it looks great. It uses flip-dot technology (like the old train display boards in in stations did) .


See also http://troika.uk.com/cloud.htm
This is how they made it

Skipped!

................and those chicken sewing pictures

Initially we made a wound

then started sewing in our aseptic operating theatre
it was an intricate job

some of us did some nice stitches

others need some more practice.

I feel like......................Chicken Tonight1

The problem:
You are a Medical student, on a surgical block. You are staying at the attachment. There are 8 of you down there. You want something to do in the evening vaguely Uni related but also relaxing (i.e. not examination).

The solution:
Get the A+E Teaching Guy to give you suture kits and tools, and all of you sit watching Silent Witness whilst lacerating and then repairing the wounds to the muscular layer and the superficial fat /skin layer......................of a multipack of chicken thighs and drumsticks.

The cost:
£1.50 for the chicken, and whatever the NHS pay for sutures and single use tools.

The pictures:
To follow

Week 1 at the Seaside!

My laptop logs me into Blogger automatically and I had thus forgotten my password, so down at Seaside hospital i was unable to post this week because I could not remember my password, and there is no wifi except for Health Board computers.

Anyway:

Accommodation
Functional is the best description, dated is another. It is just uncared for. Not that it is dirty, or even dangerous, it just ahs no owner and thus no proper care. They have bought new LCD TV with built in DVD player though, so it is not all bad! We Surgical students are spread between 4 house on a cul de sac, with normal people living in the other houses whoich are/were local aauthority social housingm, though some maybe let to short term doctors from oevrseas who are working at the hospitals as well.

Teaching
We get a lot, but mostly of the tutorial kind, with only a few examples of bedside teaching. This we stalk the wards late at night (ok, 5.15pm) looking for patients and such like to examine. We also get (another) 5 day course in the care of critically ill patients, but this one includes a day in SIM-MAN up at the angry hospital.

Travel
Well I stayed down for all 4 days and did not miss my flat too much, except for the broadband and freeview the latter will hopefully be solved by taking my box with me).

Entertainment
Tuesday night is pub quiz at 9pm; the FY1's also enter a team, They came second and the 2 teams of medical students (both teams were a mix of medical and surgical students) came joint 3rd, but the other team beat us in the tiebreak! Wednesday and Thursday, we watched Silent Witness and muttered about the pretentious Medical Student in it (so clearly at a London Med School) and also tried to second guess the plot twists.

Is all advertising good advertising?

And this in the week that Sir Ian Blair was fired, and the ongoing inquest intoo the events of 22/07/05 continue......

Thoughts on life and death

See here and here for starters. It has been a strange week all round really. With the main features seeming to revolve around life and its two extremes.

One one hand my sister's brother-in-law and his wife had a baby (well he didn't but you get the picture) on Monday - their first, and only 2 weeks late! I got the text about it on a day iw as talking to a patient on placement who was in for a knee replacement, and yet, had been swimming until 6 weeks before, helped into the pool by friends, because in the pool she could move freely and with less pain. She had been a runner from being you and ha been very active until her knees developed osteoarthritis about 4 years ago. They were the positives.

Then today I was writing up two cases. One is a woman whose son was horrifically injured 7 years ago, and who died last year. She herself has had Oesophageal and soft palate cancer for 7 years, and had a recent acute admission with gallstones. She spoke of the future with so little hope and expectation, and seemed to have a very low quality of life, due to her illness and the side effects of the vaious therapies. The patient is depressed, has problems sleeping and can only consume liquids, but still smokes 60 cpd to help with 'the stress'

The second is a lady with alcohol problems. She drinks a litre of whisky a day (28 units) at home, and sometimes goes out with friends. She was admitted with acute pancreatitis, and is the same age as my Mum, yet was very slow in spoeeach, tired easily, looked about 70, cannot walk waell due to bruises and breaks sustained whilst drunk. Her mouthw as a mass of ulcers, and her blood results indicate severe hepatic disease of one type or another, as well as acute pancreatitis and gastric erosion. Again, she had no hope for the future, and was convinced that only by drinking could she escapoe the situation she was in.

In both cases, I have struggeld in my write up to avoid being judgemental, and yet to try and understand their thinking, their viewpoint and how best to help them (albeit in a hypothetical Management plan). And yet, we get 2 or 3 such cases into the wards every week on this small unit.

So I find myself, having written both cases up, needing a small reminder of the positives of human nature, and why we as creatures care for each otehr, and as asociety why we demand that the NHS care for everyone equally regardless of status or outlook. I guess I'm tired and just a touch drained after 4.5 weeks in DEPCAT hospital.

How long have I got?

Leaving aside any politics or debates about the pro's and con's of our welfare state, and pension system (which in fact predates the welfare state - the random facts you get from watching BBC4 documentaries, or was it QI?) , this makes interesting reading. If we lay all the economics and social policy stuff about pension pot, and actuarial scales...something I don't even profess to comprehend let alone understand, one table hit me:

Lowest Life expectancy at age 65
432	Glasgow City	Scotland	13.8
431	Inverclyde	Scotland	14.9
430	North Lanarkshire	Scotland	14.9
429	West Dunbartonshire	Scotland	14.9
428	Renfrewshire	Scotland	15.0
427	Knowsley	North West	15.3
426	Manchester	North West	15.3
425	Liverpool	North West	15.3
424	Hartlepool	North East	15.4
423	Cannock Chase	West Midlands	15.4

Copy and paste directly from BBC Website on 30th September 2008

Note how the bottom 5 are all in the area covered by my beloved Medical school. One factor that those of you not familiar with the West of Scotland can be seen in this map
Sitting squarely between Glasgow City and North Lanarkshire, and adjoining West Dumbartonshire is East Dumbartonshire, and area which one might except to have a similarly poor life expectancy for its 65 year old residents. Except that it does not. If we look at other statistics in teh full report (here) we see that East Ayrshire adnd Clackmannanshire also have poor life expectancy figures. And yet, East Renfrewshire does not.

There seems to hjave been some nice games played when the old Strathclyde region was divvied up in the 1990's, to create the unitary authorities you see on the map above. The two areas I identified, East Dumbartonshire and East Renfrewshire also have very high (for West of Scotland):

• school exam results,
  
• owner occupier,
  
• car ownership,
  
• house prices,
  
• health indicators
• incomes.

It seems that there was a plan to create these areas of middle-upper class suburbia perhaps by civil servants who wanted to create areas for people like us? Note how there is a real U shape in the top of Glasgow to shoehorn East Dumbartonshire (Milngavie & Bearsden) between Maryhill and Drumchapel housing schemes which stay in Glasgow City. They also have lower council tax, and allegedly better services. And who lives in these areas? Well there are a fair few Consultants, Civil Servants, Teachers, University Lecturers, professional people and accountants/Lawyers. They get the benefits of city life, with the benefits of suburban council taxes. Now Greater Glasgow maybe too big for one council to run it, but there are other options to divide the area.....

The local health profiles designed by the ISD of NHS Scotland are interesting reading (unless you are a Glasgow First Year Medical Student doing Block3/4 Community Diagnosis coursework, or year 2 Family Project coursework). Similar are available in England. They also offer tobacco atlases! I can't stand doing statistics but I like graphs and maps... Maybe epidemiology is worth understand after all, but I still don't think I could deal with a career in public health.

Seaside hospital and the health form

Seaside hospital does seem a little odd though. Over the past 4 years, I have been to 10 different hospitals, and in none have I been asked about my health. The Uni did the HEAF test at the start of Year 1 Hep B and Rubella status tests before Year 2 but no more. However, seaside hospital wanted us to complete a full Occupational Health form, demanding details of medical history (thankfully brief), alcohol consumption(!), and immunisations - the full list of immunisations to give details on was:

• Tetanus (date of last immunisation only)
• Polio (as above)
• Diptheria (as above)
• Thyphoid (as above)
• Rubella - Date of last immunisation, date of immunity test, result of immunity test; Have you ever had an MMR?; Have you ever been diagnosed with mumps?
• Hepatitis B - doses, date of last dose, date of last blood test, titre level, date of next booster

This sent me rushing to Uni Health Service (for BCG, Hep B and Rubella data) and to my GP surgery for the others. At the surgery the receptionists showed me my medical notes based on my confirming my address and D.o.B, only for me to discover that the only things in my GP medical notes are the list of immunisations I have received!

At least I now have a composite list of my immunisations though.

interestingly, the university had not informed the GP of the result of the HEAF test, and the GP practice had not recorded the titre level for Rubella or Hep B, merely recorded that they were acceptable as an indication of immunisation.

Still I have now sent the form off, and hope that it is acceptable.

Introducing Suburban Seaside Hospital

This weekend is the Monday Holiday in the Health Board where i am currently on placement, so a 4 days weekend!

I utilised today by a period of meditative activity (i.e. a long lie) then started to scout out my next placement location. From Depcat Hell, I will be at the Suburban seaside hospital. Well it's not on the prom, but its a darn sight closer than my flat is.

I decided to find someone with some knowledge of the area I'd be going to, and indeed who knows the road very well. Step forward the ubiquitous Butcher Boy. the tattooed drinker also knows the area well, but he had films to see and drink to drink. We set off shortly after lunch and had a good journey down, despite the obsessive changing of the speed limit every 5-10 miles, The trip takes about 50 minutes, so is almost commutable - although we do get accommodation at the hospital if we choose to use it.

The biggest surprise was the fact that there's no two ways about it, the hospital is bright yellow. Most around here are Concrete or Stone. This one is yellow brick and looks both quite nice and quite odd at the same time.

We then went for a rather nice lunch in the Boot of the old town, near the courthouse and beach, before heading for the 'burbs, where I dropped butcher Boy at his parents house and he did some carjacking, and I drove back up to the big smoke.

Who said public holidays were restful?

I can survive 38 seconds.............

I could survive for 38 seconds chained to a bunk bed with a velociraptor

Lost in the post

While posting my sleep rant, I found this saved draft which I had forgotten to publish, so here goes.
------------------------------------------------------------------

The other week I bought a jumper, on which the sleeves were too long (stop laughing) because although my body is normal size, it would seem that my shortness is due to short limbs (allegedly). Anyway, being useless with such things, I left the jumper with Mum & Dad, and Mum took it to a place near home to have the sleeves altered. Mum expressed herse;f very pleased and said you would hardly notice that it had been altered. Because they were going away on holiday, and I wasn't sure when I would next be down there, Mum posted it up to me, certificated and everything.....

3 weeks later it is still not here. Nor are the books I ordered lastweek.

I know the post office is busy, but it seems that only my bills get through. And there isn't even a scuccession of red cards telling me to go and collect a parcel because it is too big / needs signing for.

The one advantage of the courrier companies is that with internet tracking, I can at least track my parcel then take a print out from the website along with passport and untility ill to an industrial estate between Cambuslang and the middle of nowhere and claim back my parcels.

The problem then is that they take my intrnet print out off me and I have toi navigate out of the industrial estate again....and of course they are all new builds, so don't show on the SatNav......

It;s 3am, for goodness sake.

Ok I'm annoyed, It is now 3.25am, and the builders / contractors working on the building opposite my flat have been working sicne midnight to a) change the advert poster on the front of the bulding and b) remove / replace / maintain the LED video wall on the corner of teh facade retention metalwork.

I appreciate that in order to do this they need to block the road outside my flat and 2 of the 3 lanes of the road around the corner, and thus they cannot do it between 8am & 5pm. But, had they started at 8pm, there would be a chance that they would be finished by now, allowing me some sleep. Instead, they brough their triucks, cranes and cherry pickers about 10.30pm, and took an hour or so to set up the cranes, cones, road signs etc then started work about midnight.

I may therefore be tired and grumpy on Tuesday!

More weddingness

On Friday I was at another wedding - one I didn't think I'd be at....you see on thurs-Friday in uni we had a "Managing sick patients" course which was very useful but also scheduled 9-4 on Friday. The wedding was supposed to be over in the capital at 1, so a good 1hrs drive.....so inreply to teh invitation, I had said that i would not be at the ceremony or reception, but would be tehre for the evening.

Well anyway, come Friday morning, and 2 of my coursemates droopped me in it, telling the course trainers (both resus officers) that I was supposed to be at a wedding. They both told me to stop being silly and to miss the course and go to the wedding. thus I found myself at 11.45 at the church, in time to familiarise myself with the PA rig and do the sound for the wedding, which seemed to go ok.

I then filled my afternoon with a pleasant lunch, and then a trip out to Livingston where I sat drinking eta in a cafe in teh shopping centre and reading a textbook, until it was time to head to the hotel for the evening reception, where betweeen 4 of us we set everything up for the disco.

Then I spent my evening assisting PhilT with his DJ set, which started slow, but really had then packing out the dancefloor by the end. This was followed by the derig and a drive back to Glasgow.....all in all a long, but enjoyable day.

Life in DepCat hell

One thing I have learned on my first Surgical block is that DepCat matters... Given that they invented Carstairs Indices6 & 7 for Scotland, and Indices 7 for the area I am in at the moment in particular.

This informs the patients we see...

• Pancreatitis (West of Scotland favourite)
• Cancer - bucket loads of it, of almost all known organs - oropharyngeal, gastric, colorectal, pancreatic, prostatic, bony met's....
• Obesity
• Traumatic orthopaedics

Being a surgical block, we haven't seen much respiratory stuff, since most are to far gone for any curative or palliative surgery. Many of the operations are not curative, and the people accept this as normal.

Many of the population in the area served by the DGH moved from the East end of Glasgow in the 1970's-80's and brought their health with them. You may remember the East End from the recent by-election and news headlines (see here, here, here, ad infinitum).

It seems that down in the lower indices, where deprivation is at a level which is hardly ever seen and which some in the UK would like to pretend does not exist, then you can expect to die young and they accept this. They view their lot as a poor one, and aim to make the best of it, but the vices of the poor are generally alcohol, food and tobacco - who can forget a local MP's comments in 2004.

Lest you think that it is all depression and gloom....the sick man of Europe as its uses as a Medical student, and since we cannot change the health we are presented with in the here and now, it gives many great opportunities for understand behaviours, trendsm, and also to see lots of pathology and cases in a relatively short block.

On a related note, I am writing up my first portfolio case and discovering
a) I forgot to ask about half the information I ened
b) I forgot to look in the notes for the other half
c) I have no idea why the patient is on some drugs
d) I have no idea what the 7 GMC themes are
e) I am now worried due to the above....any support anyone - the email link should work :)

Fireworks on TV

Given that 4th year starts at 8.30am tomorrow, I decided not to go through to Edinburgh to see the end of festival fireworks this year. http://www.stv.tv/content/out/edinburgh_festival_2008/fireworks/index.html

STV were showing the fireworks at 10.20pm, just an hour and 20 minutes after the fireworks concert started.

However it is awful. The music takes priority over the fireworks, it is split up by the adverts, and talking bits and mini-documentaries about the fireworks, orchestra and music. It is nothing like the real thing, standing in the rain in Edinburgh and unable to hear the music except on a walkman, talking to friends and hearing the loud whooshes and bangs as the fireworks trace across the sky. the TV show is more about the concert than the music sadly........

Guess next year I'll just have to travel through and brave the packed M8 or packed trains.

Roadtrip

Stefan, our crazy german from work* is moving to St Andrews to study Phoilosophy or some other subject suited to the rarified air up there. On Thursday, his girlfriend, Sarah (who also used to work with us all), and I helped him load an Arnold Clark van with some (by no means all) of his stuff to move up there. It took us almost 2 hours to load the van because of
a) a spiral staircase with a lift in the middle
b) lots of heavy boxes
c) 2 sets of steps down to teh car park from teh flat
d) the narrow path from teh front door to the car park then between teh cars to get to the van
e) the scary landlady who wanted to engage us in conversation and for us to help her find a new tenent.
f) Stefan kept trying to force us to eat Snickers

With all this complete, Stefan and Sarah went off to St Andrews, and I went home for Lasagne.

At 10pm, I picked up Butcher boy from work (note the recurring pattern) and we set off by Ka. Buther Boy had come eqiuiped with Haribo, Capri Sun and his MP3 player and phone so we mixed music and comedy podcasts. 1h50 minutes later, and an exciting tour of Fife later (Butcher Boy also wanted me to learn to slow for roundabouts), we arrived in suburban St Andrews - we had to detoour through the town then out to the modern houses where Stefan will be living. Itw as weird - very quiet, no one about, mowed lawns, neat gardens, nice cars and very nice houses - a long way from the West End (or City Centre) of Glasgow.

Afetr unloading the van and receiving a guided tour of the very well appointed house, and commenting on how the heating seemed to be running full blast, we took our leave (after another Snickers) and headed back. This time the SatNav took us via Leven and Kirkcaldy, which made for an interesting change of route back down a nice fast twisty road, and past the Smirnoff warehouses to the Forth Bridge and then across to Glasgow, were I dropped Butcher Boy off at around 3am.

All in all a fun road trip to end my summer holidays.

Tonight is Sarah's goodbye party as she is off for a year in Germany, which leaves the badminton plans totally up in the air. We could get one of Butcher Boy's flatmates to come, but they are both very good, and I would just be humiliated.....

*He actually left work over a year ago, but we still see him at Cheesy, Rev, badnminton, the pub so it seems like he never left.

Edinburgh Fringe visit 2

Today Butcher Boy and his flatmate Rob (who was also a former colleague of us both) and I went to Edinburgh to once again take in some comedy. This time we saw 3 shows, all of which were recommended or chosen by butcher Boy himself.

Well what can I say, but he scored a 3/3 in terms of good choices.

Special mention to the St Georges Med School Revue for their irreverent and politically incorrect sketch show of jokes, gags characters and such like. Who knew that Austrian incest, imprisonment and rape could be so funny, or that Australian diagnostics was so unusual. They are only on until Monday, but if you get a chance I can only recommend that you go - Sweet Grassmarket in the Apex City Hotel. There is swearing, sexual content and deeply politically incorrect jokes, but they are hilarious. Well done to them for bringing it on tour!

http://www.edfringe.com/shows/detail.php?action=shows&id=314

Norway

I am now back from my 3 days away in Norway (and a weekend at Mum & Dad's before that) which was rather nice and relaxing and consisted of looking at the sea, walking round on deck, observing Fijords and reading many books, as well as food and thinking....so all quite relaxing for 72 hours :) Below are some of my better pictures......

A quick note from England

Just a quick note to say that I will not be posting much this week as I am off on a Cruise to Norway for 2 and a half days. It should be fun, and either way I'll let you all know later in the week.

On a related note, I have now left my summer job and am preparing for placement 1 on 2nd September - the reason why the 2nd not the 1st of September will be explained in a future post I think. anyway I am currently in Torrential (rain) Tyneside and stealing Mum & Dad's slow internet to type this - I suppose I am slightly happy that my new 13mbps internet connection was connected on Friday, along with a shiny Be box to connect through.

Contrasting Comedy

Today I went across to see stuff at the Edinburgh festival (as opposed to doing stuff at the festival). I went to see 2 Fringe shows, both comedy, of very different styles.

The first one was Roy Walker from Catchphrase, who did a very good show at the Assembly Rooms, it was all about his life and career with many anecdotes and jokes, and jokes that other comedians had taught him. He was 'teatime on a Saturday' style comedy throughout. He even finished off with a game of Catchphrase, and his 'Car Park Catchphrase' from the Chris Moyles show. Sadly I was not quick enough to win a T-shirt.

One of Roy Walkers comments was that Comedians of his era told jokes, while Comedians today have more of a narrative style. So it was wirth Richard Herring, whose 17th Fringe show (The Headmaster's Son) was focussed very much on his life, wityh lots oif self analysis, some risquee subjects and the feeling that itw as half therapy and half a comedy show. All very funny but equally sometimes uncomfoirtable and disturbing.

All in all a good day out, some nice (half price) food and good comedy. Part 2 is next Friday!

Meet Katy

Hi everyone....

I've been a bit quiet here recently, with working almost full time and getting ready for the festival and such like I've been a bit busy and life has been bobbing along.

However, one big change has happened so meet Katy....

Yes, I'm sorry to disappoint those of you thinking that I had a girlfriend, but according to my sister, my new car (or Ka) is called Katy. It's great, and after only 4 days I'm noticing how much easier life is, and because i have only had to fill it up once so far I haven't noticed the big expenditure, since most of the 500 miles covered this weekend would have had to have been done , by train or bus, if I had not had the car. It does make the trip home from Edinburgh with lots of stuff easier, if not quicker.

One downside is that I can only park near my flat between 6pm and 8am, which should be ok once on placements, but until then means I have to park a 10-15min walk away outside the parking zone, since my flat wa sonly converted from offices in 2004, after the date that the council decree they will give parking permits for....... and because that 'free' parking is in the 'East End', I'm a bit worried about the car.

Sunshine

Over the past 4-5 days, Glasgiw has had weather not seen since last summer - 5 days of lovely warm bright sunshine, and cloudless skies and associated heating up. The difference between night-toime and daytime temperatures at the moment is only about 6C.

And if there is one thing that fells me like an axe, it is humidity.. It has been better the past 2 days, but last week was killing me - waking up with a sodden T-shirt from sweat, the going to work for more of teh same etc. It w as crazy. Thankfully my body seems to be making the necessary adaptations, but I astill drinkibng 5 litres of fluid a day.

However, there has been more sitting in the park enjoying the sunshine this year than I ahve managed before., and I am (dare I say it) even starting to develop a suntan. My memories of past Ednburgh Festivals involve warm sunny afternoon as welkl, so hopefully I can develop a sun tan to at leat look like I might have had an interesting sumemr before I emet up with teh rest of my year group in September to see the oens who have spent 4 weeks in St Lucia, or Australia, Texas or Malta etc.

The plan of my life

My cohort listings for the next year are out. Starting from 1st September, I;m on a rotating pattern of 5 week blocks, which are (in my case) in order:

Surg 1 :Surg2 : SSC :O&G : PM : SSC : Med1 : Med2

Some of it is in new hospitals, some in ones I have been to, and some in hospitals I hate.

We now have to choose our SSC components in the next 2 weeks.

I passed again

I am now one of the few Medical Students in my Med school to also have a First Aid at Work qualification!

My weekend

It was fast, fairly new, shiny, red, 1.8litre, turbo, alloy wheels, it accelerated well and was lots of fun. And it wasn't mine. I had my sisters car for the weekend to get to a wedding, and despite clipping an alloy on a curb, I have to say it was great great fun.

I now sooooo need a car. The issues of having one - problems of parking in central Glasgow, cost of petrol etc, are greatly outweighed by the advantages - go shopping anytime, go to see people miels away, not live your life by a train timetable.

Anyway I now have the money in the bank for a new car and am scouring the second hand car websites looking for likely candidates then I shall drag my brotehr-in-law around these garages to look at cars!

It's enough to make you buy a car.....

Sunday I was through in Edinburgh (again) and went for lunch with some friends. After this I decided to head home, do some chores and prepare for the First Aid course on Monday. I got to Haymarket at 1631, one minute after (as I now know) a signaling cable serving the are North of Edinburgh, was cut by vandals /thieves, after the copper for it's scrap value.

After waiting around Haymarket for 65 minutes, it was obvious that tehre were no West or Northbound trains goibng to happen in the forseeable future. I went up to sort out some stuff I need from the tech kit for a wedding coming up soon. I then went for coffee with some friends...., well actually Tea (much poorer than the second offering at Tchai.... but with a more Bruntsfield atmosphere). Then I headed down by bus to Waverley.

I then joined the nice long queue for a Rail Replacement Bus which was to take us to Linlithgow and then we would catch a train from there to Glasgow...or that was the theory. We have now reached 2030 - 4 hours after I first started to go home. We boardd the bus about 9 and headed off on a FirstBus rattling double decker out to the M9 and up to Linlithgow. After waiting on the platform there until about 9.45pm, a train came in which was going to Dunblane. After it had gone, there were 7 of us waiting to go to Glasgow.

The driver train manager came over and told us he was booking Taxi's for us. The first one came and 4 people were loaded into a Skoda and set off Glasgow bound. Then after a further 10 minute wait a Taxi came into to take us 3 to Glasgow via Croy. Thus, I travelled from Linlithgow to Glasgow in a Jaguar XJ, and very nice it was too.,

The driver was very friendly and had previously been an Executive chef, and trained at the Savoy in London, before working in Edinburgh. He was a good raconteur and was ta;lking about the joys of his job as a private hire driver and dealing with top class clients and such like.

Itw as one of the most comfortable journeys from Edinburgh I have undertaken, but took 2 hours traveling time, and over 6.5 hours from starting home to getting to Glasgow.

However after traveling 300 miels by train in the past 4 days, it was the only delay. Another compenstaion form is winging its way to First Scotrail in Fort William now......

Tea or not tea

Today before badminton, Butcher Boy and I went to a tea house - Tchai Ovna - in the West End, down by the river. It was a very unusual place which could have looked very rural, were it not for the back of the new Unite flats being built next door with cranes and builders. We sat on the decking outside on some of the assoreted seats and mismatching coffee tables and read the Menu of 100 tea types.......we chose teh House Special as a start - it was a very sweet milky tea with a distinctive spicy hint to it. I think Butcher Boy liked it more than I did. we sat discussing the world and putting it right whilst looking out through the foliage to watch the builders.

after deciding that it was maybe too large a leap from out tetley, Twinings and Yorkshire tea palate, we decided on a rather refreshing balck tea to follow which was lovely.

Upon paying, the staff asked how we had enjoyed it and seemed alittle surprised thatw e found the spicy one not to our pallette. Butcher Boy was at his most mollifying in trying to convince them that is was our uneducated pallettes which were to blame, noit their random teas.

I feel we shall visit again, maybe starting to get more adventurous with our black, green, yellow white and even red teas. however, i cannot see either of us trying the fruit pipes they offer as a smoking alternative.

MIA

Sorry for being Missing In Action for the past 2 weeks or so. I would love a very complex excuse but, no to be honest it is just pure laziness. I will therefore try to summarise life here:

• Badminton
• Work
• First Aid course
  
• messing about on the internet..............
• reading trashy books of varying descriptions

and that is about it.

Badminton
Well we have been playing as a group of between 2 and 6 more regularly over the past few weeks, except for the week of Butcher Boy's confinement due to having had his eyes lasered back together. My ability is as ever exceded by my enthusiasm and my hope that i may improve. no one seems to mind much and so we continue to attempt to counteract some of the many calories consumed.

Work
In a change to when I last worked there, I am now working mostly on checkouts. this involves less cleaning and less interaction with chicken grease, which is all good, but does involve more dealing with customers and the vagrities of the human condition from drunk to druggie from elderly to eccentric and from kids to kleptomaniacs. I have also been covering a few shifts on the Kiosk selling addictions - from cigarettes, through skins, through alcohol through gambling to newspapers and sweeties, if you want to feed you addiction, I will happily sell it to you, as long as you look over 21, or from next week, over 25 (or have ID). I have been working an average of 22 hours which is about enough to keep busy, without it not feeling llike a holiday.

First Aid Course
2 weeks dpone now, and half way through the course. It is a mixed bunch of people, mostly very nice and all seemingly willing to get into the spirit of things. There are a few of us about the same age who seem to get on and have been doing the practical exercises together. Only 2 weeks til the assessment so I am reading books again!