"Days in the MSF clinic can veer between hectic - seeing hoards of outpatients; over 4,000 a month) and unreal - truck upon truck of patients with gunshot wounds arriving within hours of each other. But the staff we work with here, who have unfortunately seen all this before, carry on with such continued compassion and determination that one can only feel strengthened by their example.

"The biggest challenge I've faced so far has been with the acceptance and stoicism of the people of Sudan. Recently I saw a boy of 13, with a horrendous dilated cardiomyopathy [disease of the heart muscle] who I could only encourage to go home and enjoy what remained of his life."

On Monday I was given the pleasure of speaking to Medicins Sans Frontieres at their meeting of their 'webby people'. I'd been warned that, based on the meeting last year, they were all rather sceptical of the use of blogging.

Unfortunately for me (who'd prepared for a fight), they appear to have come round to the idea nicely, there was a general agreement that social networking and blogging wasn't in fact a huge terror.

Also at this afternoon session was Karina Brisby of Oxfam and Tom Mansel of Justgiving.com (who have helped people raise more than £240 million for various charities). I was there as someone who (a) blogs, (b) has turned out to be quite sucessful about it and (c) has managed to do so without getting fired.

The general gist of the chat was essentially that you *can* trust people to blog responsibly, that people are more interested in what individuals have to say rather than PR departments and that blogs enable storytelling which interests people more than dry accounts of situations.

And that sometimes a picture is worth a thousand words.

They are a good bunch of people, and the stuff that MSF deal with makes my problems (and the problems of a lot of the people I go to) pale into insignificance.

They certainly gave me a lot to think about.

It's all the fault of Sony - they've turned me into a lawbreaker.

While I was America (nice place, shame about the government - although you may as well say the same thing about the UK) I spotted a demo model of the Sony Reader (PRS505). I'd been wanting to see what 'E-Ink' looked like so I had a bit of a play around with it and thought it was rather nice.

As I am a nerd and a shameful first adopter I managed to wrangle one into my grubby little hands.

It's really rather clever - the screen is easy to read, it's light and thin and it doesn't feel like you are reading things off the screen. You load the books onto it via your desktop/laptop system (and the software isn't Mac compatible, but there are workarounds).

So it came time to load some books onto it. First stop was the Sony Reader Ebook Store. It is from there you can pay for and download e-books. I quite fancied the Neal Stephenson 'Baroque Cycle'. I own them in 'dead tree' edition, but have never managed to read the whole three because the books are physically huge.

And then I hit a snag.

You see, you need a credit card that is registered in America to buy things from the store. Being a simple traveller from the UK I don't have such a thing. So my money is no good for them.

**Insert clever joke about current £/$ exchange rate here**

I want to give them my money. I give Audible my money for audio-books, I give iTunes my money for music downloads. But the rules of international marketing and the dumbness of Sony means that I'm not allowed to read their books.

What to do, what to do?

Well, I could scan the books in to my computer, perform OCR on them and put them on myself - but have you see the length of them? I could transcribe them myself, but then I may as well be reading them.

So instead I hit the bit-torrent sites and downloaded them.

I now have slightly wonky formatted copies of the books that I already own, books that I would have paid money for again for the ability to read them on my sexy new reader.

So lots of people have missed out on a sale.

Back in the day I used to illegally download music - now I have the ease of use of iTunes or eMusic, one day hopefully Amazon in the UK will offer music downloads. I'm happy to pay for these downloads because (a) Its the right thing to do and I'm no longer a skint student (b) It's just easier.

When video rentals for iTunes arrives on these shores I'll be using that, or a competitors service.

I like paying for my media.

I've downloaded books from Project Gutenberg and from Archive.org (including my own book), but I want to give real authors real money for the privilege of being able to read their books.

But Sony says I can't.

The counter argument is that I have no 'right' to format shift works that I already own - move, for instance, bought CD music into the MP3 format. Yes, if you've done this then you have broken the law and the record companies can sue you into bankrupcy. Allowing this 'format shift' is one of the key recommendations made by the Gowers report (even though the government is being slow to bring it into law).

Ethically I don't think I'm doing anything wrong, if I'm allowed to resell books that I've bought (which I am) then why can't I reformat them into another readable format for my own personal use.

But by making me jump through these hoops I'm reduced to illegality.

---

With no work until Thursday, and no stories in my 'big black book of interesting ambulance stuff' I'm stuck writing about other things. Oh well, normal service will be resumed soon.

I feel relaxed. I had time on holiday to rest and recuperate. I sat around and did very little, no writing, no thinking about writing, no picking up drunks. It was bliss and I'm rather sad that it has come to an end.

I feel re-invigorated.

I feel re-susc-i-tated.

I'm also going to release, that is to declare bankrupcy over my un-answered emails, any podcasts I have left to listen to and all the RSS feeds that I need to catch up with. I don't like doing it, but I honestly have no time to catch up on all the things I've missed out on during the winter doldrums. This is a failure on my part. If you are expecting an email reply from me and it's important then please send the email again and I'll deal with it as it comes in. For all those people who emailed me to thank me for the book or the blog, I do read them all and they do all bring a smile to my face.

What this will allow me to do is rebuild some form of workflow and get involved in some interesting new things, some of which you will see on this very blog, some will be at one of my other internet 'hang-outs'.

So, this break has given me the chance to catch my breath, absorb some honest to goodness sunshine, and restart with new vim and vigor.

Rebooting in 5...4...3...2...1...

(And of course, as soon as I finish typing this blog-post while at Florida airport they announce that my flight will be an hour late and so I'll miss the connecting flight back to the UK. Bollocks).

A very quick blogpost and you may see why once you finish reading it...

05:25 - Wake up, stumble out of bed, shave and get my clothes on.
06:45 - Arrive at work, find there is no milk, so no cup of tea.
07:00 - Discover that there are no adult oxygen masks on the ambulance or in stock.
07:03 - First job.
Job
Job
Job
Job
11:28 - First (and only) cup of tea of the day.
Job
Job
Job
etc...
18:35 - Miles from home we get our last job.
19:09 - We finally manage to get the heavy immobile (but very nice) patient into the ambulance.
19:20 - We reach the patient's hospital, miles from station.
19:40 - I find a nurse to hand over to, our patient is likely to be on our trolley for a few hours - I point out his high risk of developing pressure sores.
19:50 - Another crew come up with a cunning plan to get us away, Control agree to it.
19:55 - We start to head home.
20:17 - We arrive back on station, knackered. Due back in work in 10 hours, 15 minutes. Not counting commuting.
20:45 - Make it home - I'm too tired to cook, yet heroically managed to blog.

Oh well, at least I have a 'not a blogmeet' to look forward to with the lovely Gordon McLean. Then the day after that...ahem. A week in Florida as paid for by my lovely mum and brother.

Yeah - I'm looking forward to a week in some sort of sunshine.

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.

---

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.)