Newbie

  My first midnight ward round in the intensive care unit, and still pretty inexperienced. The patient in cubicle 4 was deteriorating. His oxygen requirement was maximal, the pressure settings on the ventilator had crept up. His lungs were stiffening, be it due to infection, fluid overload or a tense abdomen... I could not be... Continue Reading →

Resilience – from within or without?

  I have been confused about resilience. To me, it always seemed very sensible to focus on it, this ability to 'bounce back from tough times, or even triumph in the face of adversity'. It surely is part of the ‘hidden curriculum’, as Horne and Peters refer to it in their BMJ article, ‘Ensuring our... Continue Reading →

Junior / Senior

  Trainee doctors tend to know more about patients than their consultants, though consultants, by virtue of experience, usually know better how to treat them.  Sometimes however, a peripherally involved consultant will parachute in and give an august opinion, but without adequate knowledge of the person or the problem. For instance, in my field, the... Continue Reading →

Dodging shadows: the mysterious art of detachment

  I watched a patient die before Christmas. He was surrounded by the full crash team, which nowadays is a fairly large group. As the attempt was abandoned, and another consultant ‘called it’, I withdrew into the background. There was nothing I could do to help. I walked away to prepare my departure for the... Continue Reading →

Reputations: the light and the dark

  A recent thread on Twitter brought up a subject that is really spoken about. Elin Roddy kicked it off with a comment that patients admitted to nursing homes should routinely be engaged in conversation about their preferences towards end of life. With habitual frankness, she later commented that there is a danger that those... Continue Reading →

In my day

Reading about the situation at Derriford hospital, where two doctors found themselves responsible for over 400 people, I thought about my own training in the 1990s. Before you slap the computer shut or throw down the phone, I should say that although there is a fair amount of ‘in my day’ reflection here, it is not my... Continue Reading →

The dead of night

Doctor fatigue has featured heavily in the media this week. There are tragic stories of fatal car accidents, and a survey of anaesthetists has revealed that half have had accidents or near misses after night shifts. As a consultant who works at night rarely now, I look back at the long nights and deep fatigue... Continue Reading →

The unknown quantity

What determines if and when patients ‘turn the corner’? I have never understood. In my world of acute-on-chronic disease, where patients suffer sudden and life threatening reverses, there are numerous stories of unexpected turnarounds. Our efforts to prognosticate accurately have led to many scoring systems, all of which have been ‘validated’, but when applied to... Continue Reading →

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