TheAnatomiser

If you’re like me, British, then probably the last time you saw Howie Mandel on the telly was in St. Elsewhere, where he played Dr. Wayne Fiscus (the guy with the big hair.) Now he’s the US equivalent of Noel Edmonds, presenting ‘Deal or No Deal’, that show which has inexplicably captured worldwide attention by getting people to open boxes completely at random.
Howie’s just been admitted to hospital in the states with an ‘irregular heartbeat’, a term which includes the A-Z of cardiac abnormalities, from atrial fibrillation to; well, there must be some heart abnormality beginning with Z, only I can’t think of it right now.

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Here’s a useful tip. If someone is about to stick a needle into you in the name of the healing arts, don’t piss them off beforehand. Even if you’re drunk and normally quite obnoxious. Here’s why.

It only works with intra-muscular (IM) injections. I’ve never practised it myself, or indeed seen it done, but I am quite certain it exists.

Most IM injections are drawn up into the syringe out of the phial they come in, using the same needle that you inject into the patient. The needles are actually little miracles of engineering, with an angled, sharpened point at the end. If that point is tapped firmly on the bottom of the glass phial while the drug is being drawn up, the point bends round very slightly at the tip. You now have a barbed implement. It goes in alright, but on withdrawal it catches on muscle fibres and tears them, causing unnecessary pain and a very nasty bruise afterwards.

As I say, I’ve never done this or seen it done. But the very fact such a phenomenon is even talked about is one very good reason to be nice to your nurse and your doctor. If you need one.

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Stories of moronic patients are second on the list of the most popularly-requested A&E ‘anecdotes (number one being, of course, the sorts of things that people insert inside themselves and then get x-rayed when they won’t come out again.)

So here’s the first of what will probably turn out to be occasional brief rants about such people.

The woman who booked in because her false fingernail had come off and she wanted us to stick it back in place.

The woman who actually called ‘999′ (the emergency services number) for an ambulance because she had chewing gum stuck in her hair. In fact the trick to get chewing gum off clothes is to put the clothing in a freezer for a couple of hours so the gum goes hard and can be cracked off. So I advised the patient to go home and stick her head in the freezer for a couple of hours.

Of course I didn’t actually. The General Medical Council frown on that sort of thing. But it’s what I wanted to tell her.

The weird thing is that a lot of medical soaps cover exactly this sort of thing these days – inappropriate use of resources, ambulances tied up with trivia while the elderly man quietly dies form his heart attack – that sort of thing. But the eejits who pitch up with their gummed hair and broken nails either don’t watch popular TV shows as they are too busy attending museums and art galleries (unlikely), or they are just so stupid that they can’t see the comparison.

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As a junior doctor working in the north of England many years ago, I along with my colleagues were conscious of the ‘Westfield Grannies’.

Westfield is one of those strange health schemes that pays out money when you are ill. Not enough money to go for private treatment or anything; just a bit of money. One of the ‘triggers’ for payment is admission to hospital – you get a certain amount of cash money for every night you stay on a ward.

Now if you have a chronic illness like emphysema or cardiac disease, you soon learn those magic symptoms that will ensure your admission to hospital. If you have lung disease, just say your exercise tolerance has decreased suddenly. If you have heart disease, say you have got chest pain that won’t go away.

The Westfield Grannies were an informal group of elderly ladies, probably unknown to each other, who would get a few nights in hospital, and then claim their cash. Like Bingo with an overnight stay and antibiotics.

As soon as the Westfield cheque came through, they’d be off to Blackpool or Filey or somewhere for a couple of weeks. All courtesy of their health insurance. And the NHS of course.

These days they probably go to Benidorm to visit their son’s crystal meth lab instead of visiting Filey. But the economics of it are basically the same.

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So there’s this bloke. And he is really quite ill. When I asked him why he hadn’t called an ambulance earlier in the course of his disease, like a couple of days ago, his response is that before today he was “too poorly to come to hospital.”

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OK, this will probably only be of any appeal to other registered medical practitioners like me who pay £290 a year (£390 from next month) for the privilege of being abused, spat at and vomited on, but have you seen what the GMC (General Medical Council) have just decided to spend some of that money on?

A lucky web designer has just been paid a small fortune to produce an interactive video web tutorial to teach doctors how not to be complete idiots. You can see it here. It’s very pretty and very well done, but as to the content…

In fact that’s the problem with a lot of the GMC’s guidelines. I guess they have to be actually written down somewhere, but if a doctor really needs to be told that it’s best to be polite where possible, honest, not to kill patients or to have sex with them (with or without their informed consent), then that person is probably already heading down the wrong career path.

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12 BILLION pounds they’ve spent. Of your money. And to show for it? Well, we can now get xray images electronically, which is nice. But also means that instead of losing the odd xray like we used to, now when the server goes down (which it does about once a fortnight – despite promises made that it never would) we can lose all the xrays at once. That’s progress. [Read more →]

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The Welsh Assembly have just announced that hospital parking in Wales is to be free. Where I work, and in just about every other hospital in England and Scotland, you have to pay money to the hospital if you want to visit a loved one, or even if you need to attend the hospital as a patient. [Read more →]

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You might have heard about the lottery winner who had to be within half an hour of a hospital at all times because of his medical condition – an aneurysm. An aneurysm is caused by a weakening in the internal wall of an artery, which allows the artery to bulge alarmingly under the pressure of blood inside. Eventually they can burst. If the aneurysm is on an artery inside your brain (as many as a third of us walk around with these potential widow-makers inside our heads I’m afraid) the result is a brain haemorrhage. If the aneurysm is situated on your abdominal aorta (the main artery that carries blood away from the heart and down towards the pelvis), then the result of rupture is usually immediately fatal. A thoracic aortic aneurysm is higher up, and more difficult to operate on. This story had me a bit confused.

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I’m going to bet you’ve never heard of saccades. Or saccadic movements. They are the jerky movements our eyes make when moving from one object to another. It’s pretty much impossible for most people to move their stare smoothly across the room – our brains naturally jump our eyes from one point of interest to another. Try it now. See? That’s saccades that is. The best way I know of moving your eyes smoothly is to fix on a point and turn your head.

Because your eyes move with incredible speed ( there’s a wikipedia explanation of the arcs and angle and things involved here) when ‘jumping’ from one point to another, you can experience some cool side effects. Some can be experienced when you’re out driving on a motorway. Best done if you are a passenger if you want to avoid crashing. Look at a car in the lane next to you. Now glance forward. Due to ‘persistence of vision’ you will experience, for a split second, a frozen image – in particular you’ll see the car’s wheels appear to have stopped turning. It takes a bit of practice, which is why it’s definitely best not to be driving at the time.

You can notice a similar effect with certain types of lights – do a saccadic jump and you’ll get a ’strobed’ effect trail if the light in question is an LED brakelight, or a 50Hz streetlight. With some of the new xenon headlamps, you can also get a streaked-out spectrum as these lamps emit over a range of light frequencies.

Anyway, that’s saccadic eye movements.

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