I've decided to delete Dr. Crippen from my blogroll. His latest post and response to comments has been the final straw and he has gone from a critic to writing things that for those of us who are used to internet communication are 'trolls' to cause argument. In this latest post he gets upset when someone mentions that a GP might have been less than perfect, and in response proceeds to insult every other medical/social care group with a blunderbus of incorrect thinking and generalist thinking.

He then goes on to answer critical comments with a standard 'you just don't understand' (implying that only he has insight into the entirety of the NHS), and that he isn't insulting nurses by calling them 'nursey'.

So I'm going to take my own advice and stop feeding the troll. No more links coming from me Dr. Crippen, you have been unwilling to engage in discussion, so I'm going to stop trying.

(I suggest other people who think the same way take the same action).

But like a hydra of goodness I remove one bad blog only to replace it with three good ones - Inspector Gadget, The Police Inspector's Blog, Mental Nurse, the blog of some mental nurses, and Mouse Thinks, the blog of an A&E nurse. All three blogs are excellent and I recommend them whole-heartedly.

DG's latest post is genius. Other people have written about such things, but not as evocatively as this post.

My memory is poor, but I'm sure that, when I was a nurse, the NMC had it as a condition of being the sort of nurse who gives drugs to people that the aforementioned nurse understand what a drug does and what it's side effects are.

It's 3am in the morning and I'm miles out of my area on the FRU*. I have been sent, as a blue light response, to a nursing home where one of their 'clients' is sleeping.

Yep - sleeping.

I get there and the patient is in the reception area of the home sitting in a wheelchair. He is... asleep.

The 'nurses' at the home tell me that normally he is very active at night and often comes to see the night nurses and sits chatting with them. He's ninety-eight years old and mildly demented.

I bite my tongue and do all the checks that I can to make sure that there isn't anything obviously medical going on. All his observations are fine and he responds somewhat when I try to wake him. I'm sure that if I provided enough pain stimulus I could fully wake him up, but it would just seem cruel.

I look at the patient's drug chart. Two days ago he was prescribed a rather strong sleeping pill.

I ponder, for about 2 milliseconds, if this might be the cause for his sleeping. At 3am in the morning.

I suggest this to the nurse.

She shrugs.

The staff don't say anything, but I get the distinct impression that they have been getting tired of this patient being awake while they are at work. If all your patients are sleeping then the night shift has little to do. If this patient has been awake, then they actually have to talk to him. In a lot of the nursing homes that I've been to the nursing staff don't like talking to the patients.

In a fair few nursing homes that I've been to the staff and the patients rarely share a language, and so everyone just 'gives up'. As a digression, the good nursing homes that I've been to have been those where the staff and patients do talk to each other, and the care of the patients is considered to be more of a 'partnership'.

The nurses, who I suspect have got exactly what they asked for, aren't happy. They've already rung the elderly relative of our patient (at 3am!) to let her know that he is heading into hospital.

The ambulance crew arrive and I have a real problem explaining to them why we have been called.

"The nurses wanted this patient to sleep at night. They have given him a sleeping pill, and now he's asleep", doesn't really seem reasonable for a trip to the hospital.

But the 'customer' is always right - and so the patient is driven off to the hospital.

I talk to the crew a few days later and they tell me that the receiving nurse at the hospital was as befuddled as the rest of us.

I don't know, jobs like this make me despair at the general intelligence of people, not less the intelligence of the sorts of people who look after the elderly.

Oh well, at least one of us had a bit of a kip that night.

*I really need to tell you about FREDA one day - perhaps a joint post with Nee Naw.

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I'd like to apologise, blogging has been a bit slow of late. Mostly this is due to working on the sequel to 'Blood, Sweat and Tea' - I'm needing to put some concentrated effort into it. this is not easy with twelve hour shifts accompanied by the utter lack of energy I have at this time of the year.

Medgadget are running their annual Medical Blog Awards - you should go over there and have a look at the nominees, there are some really good ones there. Also there is no other motive for suggesting you visit the link. No. None at all...

Some time ago I got tagged with the 'Seven things' meme from Diabetes Mine. I don't normally do memes, I've often got enough to write about (at the moment I have a little black book that is full of article notes and ideas, this makes me feel relaxed and unconstipated).

The meme is to write seven random things about yourself. I'm supposed to write it and then pass it on.

The problem is that I am pretty open and simple, so I don't think that I have seven random things that I can tell you. Honest. Well...nothing that wouldn't get me arrested.

So I'm turning this around - why don't you tell me seven random things about yourself? Leave them in the comment section and I can get to know you all a little better.

Go on, have fun...

If they are good I might be inspired to do my own.

(You can read Diabetes Mine's seven things here.)

Two consecutive days at work, both starting and finishing exactly the same.

Both days start with an early morning call to a 'maternataxi' which, while I moan, is a nice way to ease into the day. Especially at six-thirty in the morning.

Both days ended pretty much the same, but that's not the remarkable thing about it.

Both calls were to GP surgeries, both patients were men in their fifties and both were suffering from a chest pain that could have been cardiac in nature. Both had been feeling the pain for eleven hours.

Both men were also in high risk groups, one a slightly overweight Asian gent with diabetes, high blood pressure and high cholesterol. The other was also overweight and had previously had a heart attack and regularly suffered from angina.

But this coincidence of time and illness wasn't the surprising thing. I'll tell you about the GPs and regular readers will soon realise what is unusual.

The GP of the first patient still had the patient in his consulting room, he'd started treatment by giving the man an aspirin, which is really rather important. As we entered the room the GP apologised for not having an ECG. He had also phoned ahead to the hospital to prepare the medical team for the patient. I explained that we would do an ECG in the ambulance and if the patient was having a heart attack we would take him to the cath-lab for immediate angioplasty. The GP didn't know that we could do this and asked if he could see the patient's ECG once we'd done it.

When we showed him the normal ECG, the GP apologised for calling us out. I told him not to be silly, as he'd had a good suspicion of the patient having a heart attack and had started the appropriate treatment, and that this was remarkable.

The second patient was also lying in the GP's consulting room. In this case, not only had the GP given the patient an aspirin, but they had also done a ECG. Not only that, but there was a typed note with the patient's medical history on it, and were in the process of phoning the patient's wife to let her know what was happening.

Compare this to the usual GP situations I find myself in.

These separate GPs had made completely reasonable diagnoses and had started treatment. This, rather shamefully, shocked my crewmate and I. We are much more used to attending to 'heart attack' patients that are sitting out in the waiting room, haven't received any medical treatment and are clutching a roughly scribbled letter addressed to 'Dear Doctor'. That, and the GP will be hiding in their room.

Two days on the trot, two superb GPs. What with yesterdays post, I may well run out of things to moan about.

Well, I can have a slight moan, both GPs booked their patient into a hospital far away from our station, thus making us late off home - but you can't have everything. After all it was the closest hospital to the surgeries.

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Can I mention, for no real reason, that Medgadget have opened the nominations for the best Medical blogs for this year. No reason at all... Nope. None.

Barely one day into the Virtual worlds forum and I'm writing about 'Time Until Penis' and 'Dildo In The Room'.

Good job I'm back at work on Saturday.

Normalcy.

No blogging for the next two days as I'm at the Virtual Worlds Forum pretending to be a journalist-blogger (don't ask...) Posts about this will be on Mental Kipple.

On Friday it's Mac Expo day, but I should have written something ambulance based before then. I'm thinking something based on a Levellers song...

VWF is rather interesting even though it is more directed towards business people, it's fun to look at what they consider important in a Virtual World as opposed to us mere consumer/creators.

The low level light in the main hall is massacring my eyes while I'm trying to take notes though.

On the subject of notes - I think that I've taken more notes in the first morning here than I did during my entire time in college.

Which may explain a lot.

Oh, and I've just done a bit for BBC radio's Pods and Blogs, Chris is a very nice chap and persuasive to boot.

Right - time for the afternoon session.

I wish they had beer here...

I've just come back home from Cheltenham. It was great fun, and I'll have a quick run down of some of the best points.

• The hotel I was put up in was so posh a tiny bag of KP nuts cost £1.75. This is not a complaint.
• I can find a Wetherspoons pub anywhere. It's a skill.
• One of the staff in the 'Writer's room' wrote her dissertation on my publisher The Friday Project, including my book in it.
• Another volunteer who looked after the panel did some work experience for The Friday Project.
• Both of the above are obviously intelligence people of taste and distinction. Also pretty.
• All the guests on the panel were lovely, as was the host.
• Jed Mercurio, as well as being lovely, has given me a lot to think about.
• Feedback from the audience was apparently good - I'm glad that they enjoyed it.
• I did my first ever signing - it was *superb*.
• I still feel like some sort of a fraud. I think that I need to get over myself.
• I managed to get my favourite book of all time signed by the author ('Microserfs' by Douglas Coupland) and I managed to blabber like a fame struck idiot at the same time.

This is the first time that I've done anything public around 'literature' as opposed to internet/blogging. If they are all as interesting, well thought out, and perfectly organised as this one I'd like to do some more.

I'd also like to thank all the people involved for inviting me - it was great.

Now - back to work at 6:30am tomorrow, and back to writing about ambulance things.

As part of my talk with the panel at the Cheltenham Literature Festival I mention that there are a fair number of UK based medical blogs. I'm linking to some of them below (in no particular order, just the order I clicked on them in my RSS Reader).

This is set to post just as the panel starts and will be the 'datashadow'. Here's hoping anyway...

The social worker blog is a bit too 'corporate' to be what I'd consider a 'proper' blog (whatever that means), but there seems to be an absence of personal social worker blogs. I also can't find a UK based radiographer blog.

Suggestions of additions to this list gratefully received.

A&E Nurse blog.

Ambulance controller.

Mental Health Nurse blog.

Patient blog.

Medical Student blog.

Hospital doctor blog.

Midwife Blog.

GP blog.

Physiotherapist Blog.

Pharmacy Blog.

The collection of Social Worker blogs (Not really what I'd call blogs, but there you go...).