Saturday, 7 September 2019

Slick Lab V Slack Lab.

   I find myself increasingly quoting Ronald Reagan: "I'm from the government and I'm here to help!" are the most terrifying nine words in the English language.  Anyone familiar with waiting around hospitals for X Rays or lab work cannot fail to be impressed by the efficiency of the private sector when compared with the civil service mentality of the public sector.  Viz my visit to one of the private labs for some blood work this week.
   I pulled into the parking lot and parked my car in a designated complementary spot clearly labelled as such.  At the hospital even a short parking stop would be $3-$4.  I made my way to the lab and since it was 10am I was not surprised to find it crowded.  A large monitor mounted on the wall listed the twenty or more patients ahead of me by first name and the anticipated time of their wait.  I checked in anticipating a fair wait and since there was a coffee shop not more than a few feet away,  I slipped in and bought myself a large coffee.
   I am a rather impatient individual so I always bring some tasks with me to keep myself amused.  With my coffee in one hand and my National Post in the other I settled myself down in one of the rather comfortable chairs to enjoy my coffee and catch up on the news.  No sooner had I settled down than I heard my name being called out.  Impossible, must be a mistake, I thought.  I looked up at the screen and saw "Stan.......waiting time ........0!  I was directed to the torture chair, where a pleasant lab tech took my coffee and placed it safely for me while she took my blood.
   I had gone into the lab at 10 am and was back in my car sipping my coffee at 10.29.
  That never happened at a hospital!!
  I suspect the whole health care system might benefit from a healthy dose of competition.

Monday, 2 September 2019

Turn on, Tune in, Drop out!

Turn on,
Tune in,
Drop Out!
Blame the Doc, blame Big Pharma, blame the Nurse, blame the health care workers, blame the porters, blame the cleaning staff. Blame everyone, that is except those most to blame, Those who most manipulate the health care system for their own ends. Those who purport to be health care experts while knowing little about health care other than how to manipulate it for political or financial gain. Maybe we should blame the society that nurtures addiction by failing to accept responsibility for the role it plays in perpetuating it and in minimizing it and enabling it for so long, Recently there has even been a move to change the terminology of addiction because those words are not acceptable anymore: they attribute responsibility to the addict, their enablers and to societal attitudes in general and that is not politically correct. How can we resolve a problem that we don't want to accept responsibility for let a!one our role in its generation through ignorance or apathy or both? Addiction and drug abuse problems have existed since long before medical records were kept. Humans realized early on that ingestion of certain substances brought about immediate resolution of all the pains and problems of the world. No, more than that. Instant gratification, instant ecstasy. Some decided that they would not settle for anything less, regardless of the cost. After all, surely a few years of ecstasy tops a long life of hard work, suffering, responsibility for oneself and others and the gradual loss of all the strength and independence one works so hard to maintain. Life is not easy and growing old is a long and painful experience for most. Unfortunately the dawn of the permissive age resulted in the decline of that ability good parents have tried to give to their children to accept responsibility and self discipline. Actions have consequences. and we have replaced that irrefutable truth with the concept of instant gratification trumping all. That was easiest avenue for the parents to take, particularly in the sixties and seventies, but there was also the misconception that it was good for their children too. It wasn't.
Nevertheless, it was the idyllic objective of most physicians to prevent or cure disease and when that end is not possible to relieve pain and suffering to make life as tolerable as possible.  At least, it was in those days. Medical students spent their youth in gaining understanding of and insight into illness, physical and mental and most of us did succeed in doing just that.
At least, that is the way it used to be until the politicians and their administridiots took over!
And make no mistake about it, they have taken over.  
So what has this to do with the current addiction catastrophe? We have to go back a number of years to grasp how we got here.
When I was a young man studying medicine in the 1950s the prescription of narcotics was not lightly undertaken. Physicians were very much aware of the risks entailed and most of them prescribed carefully and judiciously. Sometimes perhaps a little too stringently but always with the intention of providing as effective relief was possible. Physician prescribing patterns were monitored by a variety of methods of varying efficiency. At some point the Heath care administridiots aided by many of the professional associations decided that they knew better. Physicians were not treating many patients aggressively enough and were instructed to be more 'generous' in their prescribing of narcotics, failure to do so was negligence. Most patients who are being treated with narcotics for pain want to get off them as quickly as possible. Precisely those patients who were at greatest risk of becoming addicted, many of whom could be adequately treated without narcotics, were demanding narcotics and cautious physicians were often admonished for withholding them, by groups who had no special skills or knowledge in this area of patient care. Patients referred to pain specialists for help in treating their addiction often returned to their family doctor on more potent medication, than they were originally on. Dosages patterns grew larger and in my senior years of practice I frequently saw narcotics prescriptions for doses that would have resulted in loss of license in my younger years. The growing permissiveness of society towards street drugs in general and opioids played no small part in the increasing flood of drugs pouring into our country. Then we act surprised at the death and destruction that ensues. And how do our politicians and administridiots react. By legalizing marijuana! Some recommend much more than just pot..

No wonder they want to blame J&J, and Big Pharma, and anyone but themselves.
Look around, "Turn on, tune in and drop out," didn't work out too well. Timothy Leary did a lot of damage!

Monday, 19 August 2019

Sad Story

                                                             Sad Story
                             
            When I heard that Don had been admitted to hospital again I dropped in to see him the next morning.   He was lying in bed and  I could see he was quite agitated. 
            "How are you?" I asked feeling rather inane.  It was obvious he was not good.
            "Not so good, I'm glad you dropped in." he said. "I wanted to talk to you".
            "About what?" I asked.
            "Well, remember the last time I was in hospital and you came to see me?"
            I nodded, "Yes".
            "I told you that there were three major problems that were troubling me.”  
   I nodded again.  Somehow I had become his reluctant confidente.
            "I told you about two of them, One was the upsetting circumstances around my father's death, and the other related to a medical malpractice case, still ongoing in Australia."
            "Yes, I recall," I said, although he had never shared any of the details of the malpractice case with me.  He wanted to leave that in Australia, but it seemed to be following him.
            "The third issue I've never told you or anyone else about," he said gravely. "It's causing me great grief."
            He said he'd never told this to anyone else before.  I wondered why he had decided to tell me.  We always got on well enough together, but we'd never been particularly close friends.  A fellow department head, he'd been recruited a year earlier as the head of the department of Neurosurgery.   His credentials were exemplary and his references were sublime and that's how Australia got rid of him and Canada got him.  Everything  appeared to be going well for a while, until Don started becoming increasingly depressed.  We had socialized a few times and I suppose I was the only family doctor he knew, so I was consulted.  It quickly became apparent that he needed psychiatric consultation.  I arranged it and it he was admitted to hospital by the psychiatrist.  He responded well to treatment and now, less an a year later he was in hospital again.
            "I'm listening," I said, not being able to come up with a more appropriate rejoinder.
            "I was about 28 at the time this took place and I'd had a really bad couple of bouts of depression, that had required hospitalization.  I had decided I would never get married and that I certainly didn't ever want any children to follow in my footsteps.  It took a lot of talking and psychiatric consultation and recommendation to manage to convince one of the urologists that I should have a vasectomy. Eventually  the vasectomy was carried out and I went on with the business of living."
            He looked at me as though expecting some sort of comment.  I said nothing.
            He continued, "Soon after that I met Maggie and fell head over heels in love with her.  We had a whirlwind romance and I asked her to marry me.  I told her I'd had some problems with depression, which, in retrospect, I probably minimized.  She accepted my proposal and we began making our plans.   I really meant to tell her that I'd  had a vasectomy, but I didn't.  I thought I'd get it reversed because I knew that techniques for reversal now had an impressive success rate."
            He stopped, took a drink of water from the bedside table and then continued.
            "I talked about a reversal of the procedure to a urological colleague about six months after the marriage, he agreed and we set a date for the surgery.  I made up my mind to tell Maggie that very weekend and to talk about starting a family.  I made a reservation so we could celebrate at a fancy restaurant that I knew she'd like."
            His eyes glazed over as he thought about the way things had unfolded. He had come home ready to keep his secret until the weekend.  He said it was a Tuesday night and he came into the house as the sun was setting. 
            "Hi darling," Maggie called.
 Was there something different in her voice tonight, he wondered?  Had the urologist called to talk to him and let the secret slip.  Couldn't be.
            "Hello," he said Putting his arms around her as she stood at the sink.
            “Darling,” she said, “I have some wonderful news for you.” 
            He had no idea what she was about to tell him.  He waited anxiously.
            “Oh what? He asked, with a cheerfulness he did not feel.
            “Darling, I went to see Dr. Woolfe today and guess what.  I'm pregnant!”
            The room rotated vertiginously and he thought for a moment he was going to faint. 
            He stopped his narrative and came back to the present.  He looked at me for a moment as if he couldn't remember who I was and tears welled up in his eyes.
            Then he went on.  “I couldn't say anything to her for a few moments, then I told her I was delighted.  We went to dinner that Saturday night and Maggie had a wonderful evening.”
            I inadvertently looked at my watch.  I had a clinical conference due to start five minutes ago.
            He caught me.  “Just give me another minute,” he said, “There’s worse to come.  The pregnancy progressed normally and we had a normal little boy.  I knew it couldn't be mine but I grew to love him anyway.  Then, just before he turned two, she got pregnant again I didn't say anything then either.  Of course I hadn't had my vasectomy reversed and so here I am with two children who weren’t mine and a wife who doesn't much care about me."
   Their kids, by the way were delightful, no matter whose gene pool they originated from. 
            The story certainly surprised me and I didn't know what to say.  I muttered that if there was anything I could do, to let me know and I've got to go now.
            A couple of weeks later Don seemed to have responded well to his treatment and seemed to be functioning normally again.  I wondered if he was going to be able to function normally as the head of the department.  When I talked to my friends who worked in his department, they said the department members seemed to have serious doubts as to whether he ever was or ever would be fit to head a department.
            Some days later, I was sitting in my office going through the mountain of useless mail that department heads waste a great deal of time reading carefully in case of missing something of vital importance that some misinformed  administridiot wanted to slip through. I was not disturbed by a knock on my office door.
            “Come in,” I said relieved to be interrupted. 
            The door opened and Hugh Dalton, the previous head of the department and current interim acting Head peered it.
            “Listen. old man,”  he had an Oxford drawl.  "I hope it’s not inconvenient but can I have a few moments of your time?”
            He surreptitiously pulled his still smoking pipe out of his pocket stuck it in  his mouth and sucked deeply.  This was just at the beginning of the days when the witch hunt against smokers was gathering momentum.
            “Certainly, sit down,” I said. “Can I get you a cup of coffee?”
            “No,” he said. "about Don; I know you're a friend of his.”
            “Somewhere between a friend and an acquaintance,” I said, self-protectively. “but we have had some social and professional interaction and he does confide in me on occasion.”
            Hugh looked serious. “As you probably know, the department members are not wildly enthusiastic about him as a department head.  I think they're prepared to give him a chance to show his colors but they are certainly not unanimous in their support for him.  They think he is not quite all there.   Recently there have been some funny goings on and as a previous department head they asked me to look into the situation,” 
            “What sort of goings on, Hugh?” I asked.
            “Well there was a Hospital Board Meeting on April 1, to discuss the future of the neurosurgery department.   Right after the meeting at which Don was reported to be more than a little upset, he had an operation to perform.  When Don finished up operating, he excused himself for a few moments, apparently for a bathroom break and then came back and remarked with a grin on his face, in a very deprecating manner that April Fools day was a very appropriate day for the Board to be meeting.  Just as he was saying this an acute emergency call came over the intercom directing the 99 Team to an emergency in the boardroom.  Of course all the emergency measures were put into action and when the emergency team burst into the boardroom with the crash cart and all the paraphernalia, the astonished Board members assured them that no one was ill or had collapsed or was in danger.  After the confusion subsided it was recognized that this was someone's sick idea of a joke”.
             He paused and a grave look crossed his face. 
            “The problem is, dear boy,” he continued, “that one of the operating room nurses who was passing by the phone outside the operating room heard Don making a call and overheard the words “emergency in the board room”.
            He stopped and looked as though he expected me to say something.
            “What you going to do about it? I asked him.
            “Look Old Man,” he said pulling his pipe out of his pocket again, “do you mind if I smoke?.”  Hugh made sure the door was closed properly.
            “No I don't mind.” I said. I still enjoyed the aromatic smell of pipe tobacco although I had given up my pipe years earlier.
            He tamped down the partially smoked tobacco in his pipe, pulled out his matches and puffed pleasurably at his pipe, all the time in deep thought.  For a moment he seemed to vanish in a cloud of bluish smoke and then he continued. 
            “To tell you the truth, the members of the department really want to get rid of this fellow.  To make things worse, he recently wrote his Canadian Fellowship and failed.  Since his license is only provisional, the question arises as to whether it will be renewed at the end of the year.  I really don't know what the outcome of this will be.”
            I had promised Don I would tell no one of his personal problems and didn't know how much of his history if any, Hugh was aware of.
            “Perhaps,” I said,” the solution would be to have him step down as department head and to function as a surgeon within the department.  I think all this administrative responsibility may be just too much for him.”
            “That's another problem,” Hugh said, “his surgical skills are also in question, at least by some members of the department.  We also recently found out that there is some medico- legal matter in Australia that is still unresolved.
            Of course I knew about that too but said nothing and was thinking about how to reply when there was a knock at the door.
            The nurse opened the office door, looked shocked at the cloud of smoke within, and had the obligatory coughing spell that non-smokers feel compelled to display in the presence of a smoker before speaking.
            “Dr. Smith,” she said, “you have patients waiting.” 
             I said, “I’ll be right there.”
            Hugh stood up to leave stuffing his still fuming pipe back into his pocket.
             “I better let you carry on with your work,” he said and a thin line of smoke followed him out of the room.
            “Yes,” I said "Keep me informed and went back to work.
           
                                            
                                                          Chapter 2

            When I next ran into Don, he exuded an air of boyish insouciance.
            “How are things?” I asked him
            “Just fine,” he said cheerfully. “I’ve just been to see my lawyer.  Did you know that they're trying to get rid of me as department head?”
             Indeed I did but I feigned ignorance.
            “I hope things work out all right,” I replied and we both continued on our own ways.
            My encounter with Don continued to play on my mind throughout the day and when I got home that night I told Anne about it.
            Why don’t we invite them over for dinner?” Anne said.  It will give us an opportunity to see if there is anything we can do to help.”
            “I think that's a great idea, I said.  “Now, what’s for our supper tonight?   Whatever it is, it sure smells good.”
            Two weeks later Don and Maggie and their two children Kenny and Elizabeth, neither of whom looked like either their father or their mother arrived for dinner. They looked like a typical happy family.  Kenny a mischievous little five year old and Elizabeth a couple of years older with a mature, reserved manner, smiled as they walked in into the warmth of  the hallway from the cold outside. 
            Don handed me a bottle of wine and Maggie looked for somewhere to put down the cake she had brought for desert.
            Greetings were exchanged all around.
            “Have a drink before dinner,” I said.
             Having filled our glasses and provided the children with soft drinks, we chatted for a while.  I don't know if it was just my imagination, but throughout the evening I couldn’t help noticing Don's lack of warmth for the kids.  It was as though they were someone else's mildly irritating kids. Which is perhaps what they were.  While most of the evening he seemed sociable and communicative every now and then he seemed withdrawn and brooding.
             “Coming from the sort of climate we left in Australia we really find the winters here are hard to take,” Maggie said, as we sat chatting over coffee.  “I think we should be looking for something in Vancouver.  My brother lives there,” she added.
            No word about Don's plight and the fact that he might soon not be able to get a license in Saskatchewan let alone Vancouver.  Frequently, Canadian graduates couldn't get a billing number that would allow them to practice in Vancouver. Don said nothing.
            “My brother would love us to move there,” she added. 
            Again Don said nothing.
            “But first,” Maggie said, “I think we will go back to Australia for a while.  Don has some business to complete there.” 
            I had heard that the business he had to complete there was related to maintaining his license to practice medicine following communications between the licensing authorities here and in Australia.
            “Oh, you really must be looking forward to a reunion with your family and friends,” Anne said enthusiastically.
            “Yes we are.” Maggie answered.
             It didn't take much to know that things were going badly.  I drew Don aside.  I wasn't quite sure how to do this.
             "Look," I said.  "If there is anything I can do to help, let me know."
             He looked me straight in the eye.  "Oh no, everything is under control.  I am sure that once I get back to Australia and straighten out things with the licensing authority everything will be fine and we will move to Vancouver.  We really need to move away from the harsh Saskatchewan climate!"  
That was that! 
             We rejoined the others and continued chatting for a little while and then  Don and Maggie and the two kids bid their fond farewells and left.   We saw them briefly once more after that, without much more than brief salutations..

                                                    Chapter Three.

            Three or four months later that I received a call from Randy Stern, a young Australian orthopedic surgeon who came to Saskatoon a little time after Don.  They had been friends since their University days.  He dropped a bombshell; Don had returned to Australia and shortly thereafter had committed suicide . This is the story he told me. 
            Randy saw Don and his family just before they left because Don wanted someone to talk things over with.  He had gone to a meeting of the Provincial Licensing body with his lawyer and came home worried and depressed.   They had refused to renew his medical license.
            “It looks as though there is nothing I can do,” he said.  “They won't renew my license and worse still they sent a transcript of the whole hearing to the licensing authority back home in Australia - and now they are going to hold their own hearing to see whether they're also going to revoke my license.”
            “Oh Don,” Maggie had said, “surely they wouldn't do that.”
            “I'm going to have to go back to Australia to defend myself before the licensing committee.  Ever since I lost the medical malpractice case they are out to get me.  Now after that I really won't have a chance.  I don't help much left to live for.”
            Maggie went to put her arms around him but he shrugged her off.
            “Darling, you have everything to live for,” she said, “We’ll get this sorted out and you have me and two lovely children to stand by your side whatever happens”
            He raised his voice angrily. “Those children are not really mine who are you trying to fool?”.
“What?” she said, taken aback, “you really are crazy.  How can you say something like that?”
“I had a vasectomy when I was 28, before we were married.  I was afraid to tell you in case you’d have called the whole thing off.  I had arranged to try to have it reversed and came home one night to tell you about it.  It was that very same night that you told me you were pregnant.”
She looked at him in amazement.  “You bloody fool,” she screamed.  “You're accusing me of having our two children by someone else.  All these years you’ve lived with us harboring a grudge and never had the guts to say a thing about it.  I’m not putting up with this for another minute.   Tomorrow I’ll phone my brother in Vancouver and the children and I will go and spend some time with him. In the meantime you can go home and get yourself out of this mess  You better see a psychiatrist first.  You are stark raving mad!.” 
“You bitch,” Don yelled furiously, "you know those two children  are not mine!”
“Listen to me, you lousy bastard, “ Maggie screamed back,” we’re going to resolve this once and for all by DNA testing.  Meanwhile you go back there and you get yourself out of this mess.  I’ll need some time to think if I ever want to see you again.”
            The next day, she and the children left for Vancouver, but not before she had dragged the sullen Don for a DNA test.

Don went back to Australia.  He pleaded his case to the Medical Board and lost his license to practice medicine.  Soon after he overdosed with his antidepressants and was dead on arrival at hospital.      Maggie had got the DNA results shortly before she heard of his death..  It proved beyond any reasonable doubt that both the children were Don's.

Tuesday, 6 August 2019

The Dopey Dope Peddlers under the TrueDope !

   The first Drug Pushers in history to lose money is the Canadian Government.  Despite all their marijuana malfeasance and their legal manipulation, the illegal pushers can still market the pot significantly cheaper than the Government can: of course the government is simply bleeding the taxpayers dollars and not their own.  Buying votes is the governmental priority and they certainly saw this as a cheap way to buy the youth vote.   They also saw it as a vast source of income because everyone knows that selling drugs is the way to make a fortune (under honest crooks, in contradistinction to the dishonest ones in government).   But when Ronald Reagan said, "The nine most frightening words in the English  language is 'I'm from the Government and  I'm here to help' he was right on the ball.  No one but the government could lose money pushing drugs, but that is nowhere near the worst of the damages they have perpetrated.   The medical consequences of long term use of pot are by no means fully known.  The legalization of marijuana was passed by a government that had not adequately investigated either the health consequences or the business mechanisms necessary to produce the end product as a source of income rather than a liability.  Our Prime Minister has probably had more experience of weed in his early years than most and HE thinks he's okay!  By all accounts his mother was no amateur either!
  After all it is only the taxpayers money that is at stake.Instead of replacing the black market marijuana that manages to produce and sells at about half the price of the legal product the Dope was not smart enough to realize that a government requires at least a rudimentary knowledge of the danger of a product that they are unleashing on the public and the necessity to produce the evidence that it is relativity safe to the user and not a hazard to the public at large.  This government does not.    The tragedy is that the Dope's move to hurriedly implement the program is going to encourage the illicit market to grow bolder, has no real safeguards against driving and other hazardous activities while high on weed, or worse still on a combination of weed and booze.          The great pride that Canada Health has voiced in reducing tobacco smoking is likely to be overwhelmed by the increase in weed smoking which is just as damaging to the lungs as cigarette smoking.  Smoke from pot contains the same toxins and carcinogens as tobacco and tends to be inhaled more deeply and held in the lungs for longer.
   Other long-term effects of marijuana include such non benign effects as temporary hallucinations, paranoia and worsening of symptoms in patients with schizophrenia.  Some studies have demonstrated that weed use is associated with reduced volume in certain areas of the brain that are involved with memory, learning and self control.  
   A large New Zealand study found that long term use starting in adolescence results in a loss of six to eight IQ points.
   The endocannaboid system is known to play an important role in the proper formation of synapses during early brain development.
   Memory impairment from marijuana use occurs because THC alters how the hippocampus, a brain area that is responsible for memory formation, processes information.   As people age they lose neurons in the hippocampus which decreases their ability to learn new information.  THC accelerates this loss in rats significantly. 
   There is considerable evidence that pot is a gateway drug and serves to introduce its users to other more potent drugs.  There is also evidence of a link between pot and psychiatric disorders.
   These are a few of the long term problems created by the premature legalization of marijuana.  With the passage of time we are like to find significantly more.
   Next time we'll take a look at the havoc and damage the short term effects can have.

Sunday, 28 July 2019

Obstetrical days at the Rotunda.

Come along with me,
Down the river Liffey..........,
To the Rotunda, the oldest continuously functioning Maternity Hospital in the world.
Established March 1745.



We were sitting in Mooney's pub, right across from the Rotunda Maternity Hospital, where they maintained a phone line specially for the students, residents and doctors on call who could have a cozy meal and a beer, while they were waiting to be called to assist in the delivery of a new addition to the human race. Sometimes the wait was long.
In those days, before anesthesia and Caesarian Section was the rule, observation and patience were paramount and CS was reserved for emergency situations. So patience was a major part of the game.
"Team B report to District Maternity Gate 2 to go on home delivery immediately."
Team B was me, and a rather older rather aristocratic English guy, whose surname was 'English' (appropriately) and a midwife neither of us knew. We didn't drink very much mainly because even if we wanted to most of us couldn't have afforded it, so there was no problem in the fact that our waiting area was a pub, rather than the squalid cells that the Rotunda assigned to us as our living quarters.
We gathered at gate 2. We introduced ourselves to the midwife and we hustled into the ambulance. Five minutes later we were at a crumbling tenement and the midwife said to the driver, "you hold on for a few minutes while I assess the situation and decide whether I am staying here or going back to the hospital with you."
"Okay Mam."
A rather motley crew Anthony English, the upper class Englishman, the Midwife, Moira O'Connell and Smith, the Irish Jew disembarked from the ambulance.
"Wait here," ordered Moira, authoritatively.
The driver could see that she was middle-aged (over forty only by a bit, mind you) and was obviously in charge.
We entered a large, old dilapidated Georgian house that had obviously once been the magnificent home of some wealthy aristocrat, but was now a crumbling tenement, housing God knows how many families. Families with four and more kids often lived in one or two rooms, peeling wall paper, with filthy floor covering that might once have been linoleum. A fireplace was the only heating, an alcove with a stove for cooking was the only source of hot water, so bathing was rare and when the large man-sized corrugated metal basin that was used for bathing was eventually filled with hot water, once every week or two it had to be boiled by the kettleful. It was too precious to waste, so Mam and Dad bathed in it first and then the children in order of seniority. Hot or even luke warm water was precious. Thus it was in Sean McDermot Street and many more areas in the heart of down town Dublin, where the once magnificient mansions of the wealthy were then dirty slums.
We walked into the shabby two roomed apartment. It was noisy, with several yelling kids with snotty noses were racing around while an older sister of about nine was trying to control them. The husband was sitting by the fire reading the newspaper. His wife, Mary, was sitting in an armchair at the right side of the fireplace, puffing on a cigarette and in no obvious discomfort yet. They both greeted us warmly, and the husband stood up to welcome us.but before he had a chance to say a word his wife chipped in.
"I told him he shouldn't be calling the hospital so early. I only just started having a few pains an hour or two ago and nothing much at that. (We called labour pains just that - it was before the time when politically correct terminology called for everything to be seen in a euphemistic and unrealistic light. After all they were contractions, not pains. After a few hundred deliveries I still think of them as pains.)
"We'll do an examination now to see whats what," said the Midwife.
We went into the other room and after getting our stethoscopes out of our bag, examined the patient's abdomen to determine the position of the baby and listen to the fetal heartbeat. She questioned us at each step, "What's the baby's position? Is the head engaged? "
Then came the really difficult embarrassing part.
"Now it's time to do the pelvic examination." The expectant mother was completely unfazed by the proceedings. She'd been this route several times before and was chatting away affably as all this was going on.
We put our gloves on, only slightly used that were kept soaking in a huge basin of disinfectant, from which we recovered them, patting them dry before we left the hospital. Both of us went through the process of examining the woman under the expert guidance of the Midwife.
"Can you feel the cervix?"
"Yes."
"Where is it?"
"Er, I don't understand."
"It's very posterior, isn't it." she prompted.
"Yes." I agreed.
"Just starting to dilate, don't you think."
"Yes." I agreed eagerly.
"Oh, I knew it was going to be quite a while," said the patient. "The pains are just starting to get a bit regular but still a long time apart. It mightn't be until tomorrow.
At the end of all this the midwife decided that it was going to be quite a while before this lady delivered.
"I want you lads to get the bed ready. I want you to time the contractions and keep a log and I want you to check the fetal heart regularly. I'll be back in a couple of hours to see how things are going."
She placed a mysterious large black bag she had been carrying in front of us.
"You'll find all the stuff you need for preparing the bed right there in the bag. You've both done your required three deliveries in the hospital and observed many, so if she comes along much more rapidly than we expect, you'll know what to do."
We were getting more and more anxious by the minute and she succeeded in topping off our fears.
"If you were getting really worried that things are going wrong there is a public phone half a block from here. You can phone the hospital and have the 'Flying Squad' out in five minutes. Anyway, I'll be back in a couple of hours and from what I can see now it's unlikely we'll be much further along."
With those reassuring words, she took her leave and left it to Tony English and me to carry on. We started to unload the black bag. With each item, kept in place by an elastic band, we looked at each other, trying to figure out just what was what.
Mary, no fool and a veteran at this game, smiled at us, pulled out a Woodbine - a cheap cigarette that came in a paper package, (the good ones, like Players came in a cardboard pack).  
"Would you lads like a cigarette?" she asked considerately.
"Have one of mine," said Tony, pulling out his packet of luxury brand fags."
She took one gratefully and so did I. We all lit up, sucked on the cigarette and inhaled deeply.
Mary said, "That first little package you unloaded is a rubber sheet, you put that over the mattress, so all the blood and stuff doesn't destroy it. The second package there is a bunch of old newspapers."  
She was interrupted by her husband: "Mary, I just have to go down and pick up a few groceries and a bottle of milk for the kids breakfast in the morning."
Mary smiled wearily. "Okay, don't be too long."
She looked knowingly at us as he left, "He's just going down to Murphy's for a couple of pints. This is all very hard on him, being out of a job and all."
She eyed us unbundling the rubber sheet that was to waterproof the mattress. On top of that, to mop up the blood and fluid that would soak through the sheet we carefully placed layers of old newspaper and anothre sheet on top.
"Yes, that's right." she said approvingly. "Now how would you like a nice cup of tea? Oh I'm just gettng a contraction," she added, holding her back.
"We better have you lie down so we can check your abdomen and the baby's heartbeat."
"Ah there is nothing much happening yet, just finish up making the bed and then we'll have a nice cuppa and then youse can examine me."
She called her eldest daughter Una, the nine or ten year old who was obviousy taking over from her until this inconvenience was over. " Make the boys here a nice cup of tea."
That's exactly what she did and although the immaculate Tony looked at his not too immaculate, chipped cup anxiously, he had the good grace to take a few sips.
In an attempt to divert attention from his poorly disguised disdain I enthusiastically exclaimed,
"A really great cup of tea, just the way I like it! " I shoved a broken biscuit into my mouth and chewed noisily.
The eldest girl came into the room again. "Is the tea alright, doctors?" she asked anxiously.
Delighted at being mistaken for doctors, even by a nine year old, we assured her it was delicious!.
"Mammy, I told the kids that they have to stay in the other room because you are going to have baby soon, but they don't do what I tell them. You'll have to talk to them." said Una.
"Bring them in here," said Mary.
Nine year old Una herded three snotty-nosed kids and carried a one year old in her arms.
"Now you all do what Una tells you," she said sternly. "She's in charge until i have the new baby. Don't make me tell your father on you. Okay, now you can go out in the street and play." 
In those days it was safe for the kids to play in the street. Una shuffled the three yelling kids out of the door and still carrying the little one said. "Don't worry Mammy, I'll keep an eye on them." as she followed them out of the room.

Wednesday, 10 July 2019

Ancient Obstetrics!

Obstetrics-the state of the art 70 years ago!


   When I started learning how to deliver babies there was no ultrasound, there were no fetal monitors, x rays were considered dangerous and not very precise. Epidural anesthesia was unheard of. Most deliveries that were considered to be uncomplicated took place at home.
   I recall coming into my office one Monday morning to find an X-ray pelvimetry report on my desk that stated, "There is gross disproportion between the baby's head and the pelvic inlet. This delivery will require a Caesarian section."
   In fact I was called at three o'clock on Saturday morning and barely got there in time for the delivery which proceeded without difficulty.
   Medical students in the world famous Rotunda Hospital got rigorous hands-on training, much of it in the slums of Dublin, 'on the district' as home deliveries were called. The 'delivery suite' might be half of a one room apartment with a sheet divider crudely hanging so as to divide the room in two. The pregnant woman and the 'delivery team were on one side of the sheet, while the husband and the kids (often several) were on the other side.
   Behind the screen was the bed, often sagging and dirty and cleaning that up and preparing it for the forthcoming event was one of the duties of the medical students - usually under the watchful eye of the midwife, who ruled us with an iron fist. The bed needed to be stripped and a rubber sheet placed on top of the mattress and well tucked in so that the mattress, which may have to last a long time would not be destroyed with blood and amniotic fluid. To stop the fluids overflowing , on top of the rubber sheeting several layers of newspaper to sop up the excessive fluids. Over this was placed a single sheet on which the pregnant woman would lie and eventually give birth.
   In those days, Caesarian Section carried a substantial risk and women often laboured for a long time. It was before the philosophy of "Never let the sun set twice on a contracting uterus" and it was not unusual for a woman to be in labour for two or three days or more, with all the attendant risks.
   Once contractions started the husband or one of the kids would jump on their bicycle and race to the hospital. None of these patients had telephones.
   "My wife (or Mammy) is going to have the baby. Send the doctor right away."
   What they got was a midwife and a couple of students. The midwife was in charge and we were there to evaluate the situation. Was the woman actually in labour? Was the baby's head engaged (down into the birth canal)? What position was the baby in?
   She taught us how to do the initial evaluation, how to do a proper pelvic examination, how to talk avoiding embarrassment for oneself and the patient. If the woman was not in well established labour the midwife would go on her way with a comment that she would be back in an hour or two after she called on some other patients in the vicinity who had recently given birth to see how they were feeling.
   "I don't think she'll be doing much for a while but if the is any problem there is a public phone just half a block away and you can call the hospital for help. ".
   This was long before the day of the cell phone and none of the patients had telephones. So two or three of us terrified students were left in charge barely aware of which orifice the baby might pop out of.
   The midwife made sure we were instructed in the patient's medical history
particularly her obstetrical history. She would instruct and supervise each of us (2 or 3 students) in doing a pelvic examination emphasizing the need to assess cervical dilation and the necessity to determine the fetal position.
   "She's not very dilated, is she?" inquired the Midwife. I had no idea.
   "Er. I don't think so,". I tried to sound as though I at least had some idea of what I was doing.
      "What about position?"
      "Er. I'm not sure." I said stupidly.
      She told me what I should looking for.
      And so it went. We students learning all about the dramatic high forceps maneuvers in rare complicated cases that we would never be called upon to do, by high powered hospital Actor-specialists and learning the vital common everyday obstetrical skills which we would need as GPs from the midwife.
    We also learned a great deal about life in the slums of Dublin and the influence of the Roman Catholic church that caused the poor and unfortunate to become even more poor and unfortunate. Ten, eleven, twelve and even thirteen children was not uncommon. I once delivered a woman of her seventeenth child and more than once I cared for a woman and daughter about to give birth at approximately the same time.


Come back in a couple of weeks and I'll take you with me on one of those adventures!
      

 


Thursday, 27 June 2019

The Pool without John.

 

  The pool without John ain't what it used to be.  Sure, I know lots of good folks and am friendly with a few but that exceptional relationship only occurs a very few times in the life of lucky people.  
   His son phoned me a couple of weeks ago to say that the hospice where John died was having a memorial evening and reception in memory of those who had died recently.  He invited me to attend and I did.  I know all his five children and they marveled as do I at the closeness of our late-life friendship.  Not many people are fortunate enough to forge such a friendship at our advanced age.
"We all wondered how two such different guys could have such a close relationship?" his daughter said to me at the  reception.  It's true.  He was an observant Christian (though I was never able to find out to exactly what specific order).   I am an non-observant Jew, so we had some good religious discussions.  He used to say to me ,"If you are right I have nothing to lose, if I'm right you're in big trouble!"
  In politics he leaned left, I leaned right.  We discussed those topics too, occasionally generating more heat than light, but that didn't matter either.  We discussed other things too, that I'm not going to tell you about here and we were never, ever, Politically Correct.
  We had a lot of laughs.  He told me cop stories, I told him doc stories and we were old enough to laugh at our youthful mistakes and misadventures that had long since ceased to be sources of embarrassment.  When recounting stories of some of the things that didn't work out he would say, "failure, the second best lesson!"
   Most of those discussions took place in various inexpensive restaurants nearby wherever we had been swimming. (see above photo) For a while I took notes and when the waitress inquired what I was doing John would tell them, "my friend is a blog writer, he's probably going to write up your restaurant."  Needless to say, he didn't tell them that my blog only had a half-dozen followers!
   Given his talent for exaggerating a little in his story telling, John, whose surname was Dell, would maintain they were not exaggerations at all, they were just 'enDELLishments.  
   Sometimes when we were lunching out my daughter in Toronto would phone.  I would immediately lose the phone while they chatted away for a few minutes.  John and Rena never met, but when his son was playing in a production of 'Les Mis' in To, he presented Rena and Bill with tickets.
   In the last few months when he wasn't up to swimming we played a lot of pool.  He was quite a good pool player despite having very poor vision in one eye.  When he played a particularly brilliant shot, he would turn to face me and triumphantly announce,"Not bad for a blind man!"
   Despite multiple medical disorders, he never complained, (except to swear mildly when he couldn't do something he thought he should have been able to)  He continued planning and doing for as long as he could. 
   In true Churchillian fashion he never surrendered; he never gave up.
   
    






























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