I like words. I like the sound they make, the pictures they draw and the sense they create when placed in a line. Onomatopoaeia (meaning imitating the sound described – e.g. ‘splash’) is a lovely word itself. In Irish nimhneach (pro. Niv-nyach) is a an onomatopoaeic term useful in a doctor’s work.
A couple of weeks ago I wrote about communication difficulties between the doctor and the patient inEnglish alone – can you imagine the issues when two languages are involved? Sometimes these issues are benefits rather than problems.
My patient was Bridie Laverne. Strange name for an Norn Irish woman– she was reared in Gweedore and Irish was her first language. She married a Welshman and came to live in Northern Ireland; when I met her she was widowed, she soon discovered I spoke a little Irish and she loved greeting me and thanking me in her native tongue. This wasn’t too frequent, I should add, as she rather disliked attending the doctor at all, whatever the language!
Bridie developed a cancer in her seventies and despite doing well for a couple of years came to the terminal stage of her life. She was nursed at home by her dedicated daughter Ann– but every time I attended her there she spoke to me in Irish, so that Ann wouldn’t understand, and wouldn’t be upset! She spoke about dying, and about her symptoms.
Sure Ann knew the whole story – indeed it was she who discovered Bridie’s cancer in the first place, while helping her in the bath one day – but maternal instinct of protecting the daughter from distress was strong.
I didn’t understand all she said, but I had enough Irish to get the drift. And when Bridie was very ill, in her last few days of life, she spoke only in Irish. (Ann remembered that her mother’s sleep talking was always in her original tongue).
We were able to ensure Bridie was not nimhneach (sore) and had no samhnas (nausea) in her final days, and bhí bás suaimhneach aici. (she died peacefully).
I met Ann the other day and was reminded of Bridie agus an Gaeilge. Cronaím í. (I miss her).
Thursday 22 March 2007
Friday 16 March 2007
Difficult Doris
Difficult Doris (not her real name) was back in to see me. I wrote about her last year – she isn’t as sick as she wants to be, she complains all the time and annoys everyone. Her hairdresser hates to see her coming. “Nobody knows how much I’m suffering, Doctor!” she tells me. “I do, Doris, you tell me every week,” I think, but don’t reply.
“That eye doctor made a botch of the operation. I can’t see a thing, now!” was Doris’ most recent complaint. Well, I had to stop myself from administering a good smack! (Deep breath - me, not Doris … count to ten…no point in getting Struck Off for failing to control my temper).
So I settled down to try to explain…
Doris had good sight in her right eye but poor sight in the left. The measurement for the left eye was 6/36 – meaning that she had to be as close as 6 metres to see things ordinarily seen from 36 metres away. Examination showed a cataract in the lens of the eye, near the front of the eyeball. The surgeon removed the lens properly but unfortunately there was a disease on the retina at the back of the eyeball, so even though the cataract was away, Doris’ sight didn’t improve much.
The problem with the retina could not be detected before the operation – after all, if the cataract stops Doris seeing out, it also stops the doctor from seeing in! But Doris didn’t care about my explanation, she just wanted to complain. Her eyesight was bad, she had an operation and her eyesight was still bad, so that must be the doctor’s fault.
The cataract operation is one of medicine’s great successes in recent years. A cataract is a change in the lens of the eye, changing it from being like clear glass to being like frosted bathroom glass. Cataracts are commoner in older people, in diabetics, in people who take steroids and where there has been damage to the eye before. The operation can be done under local anaesthetic and doesn’t seem to take long. Suddenly the blind can see! Well – sometimes. If the cataract is the only problem and the rest of the eye is healthy, then it works wonderfully. If some other part of the eye is diseased, as in Doris’ case, it doesn’t.
It takes years and years to train to be an eye surgeon. The skills needed are needlework of the finest measure, a steady hand and of course good eyesight in the surgeon him/herself. The artificial lens that is put into the eye is tiny and delicate, and any slip can destroy it. The surgeons deserve great praise for their skills and the years of learning, and certainly don’t need Doris’ unfounded whinges.
Doris then wanted praise… “Other people would sue the eye doctor, but I’m not that kind of person!” see told me. Mmm. “In this case, where the operation was done properly and the problem was caused by diseases, not doctors, there would be no chance of showing negligence.” I told her. I think that only made her grumpier.
“That eye doctor made a botch of the operation. I can’t see a thing, now!” was Doris’ most recent complaint. Well, I had to stop myself from administering a good smack! (Deep breath - me, not Doris … count to ten…no point in getting Struck Off for failing to control my temper).
So I settled down to try to explain…
Doris had good sight in her right eye but poor sight in the left. The measurement for the left eye was 6/36 – meaning that she had to be as close as 6 metres to see things ordinarily seen from 36 metres away. Examination showed a cataract in the lens of the eye, near the front of the eyeball. The surgeon removed the lens properly but unfortunately there was a disease on the retina at the back of the eyeball, so even though the cataract was away, Doris’ sight didn’t improve much.
The problem with the retina could not be detected before the operation – after all, if the cataract stops Doris seeing out, it also stops the doctor from seeing in! But Doris didn’t care about my explanation, she just wanted to complain. Her eyesight was bad, she had an operation and her eyesight was still bad, so that must be the doctor’s fault.
The cataract operation is one of medicine’s great successes in recent years. A cataract is a change in the lens of the eye, changing it from being like clear glass to being like frosted bathroom glass. Cataracts are commoner in older people, in diabetics, in people who take steroids and where there has been damage to the eye before. The operation can be done under local anaesthetic and doesn’t seem to take long. Suddenly the blind can see! Well – sometimes. If the cataract is the only problem and the rest of the eye is healthy, then it works wonderfully. If some other part of the eye is diseased, as in Doris’ case, it doesn’t.
It takes years and years to train to be an eye surgeon. The skills needed are needlework of the finest measure, a steady hand and of course good eyesight in the surgeon him/herself. The artificial lens that is put into the eye is tiny and delicate, and any slip can destroy it. The surgeons deserve great praise for their skills and the years of learning, and certainly don’t need Doris’ unfounded whinges.
Doris then wanted praise… “Other people would sue the eye doctor, but I’m not that kind of person!” see told me. Mmm. “In this case, where the operation was done properly and the problem was caused by diseases, not doctors, there would be no chance of showing negligence.” I told her. I think that only made her grumpier.
Monday 5 March 2007
A Load of Groins, and Bill McLaren
The football commentators were at it again yesterday – referring to ‘testicles’ as groins. They must know better, but some strange shyness comes over them when a footballer gets felled by a ball in the balls. The tv men mustn’t have been reading our website: (http://www.bbc.co.uk/northernireland/mindyourself/) where we tried to help with the words. I wonder what they say at the doctor’s? A lump in the groin is very different from a lump in the testicle – the doctor could be examining the wrong part.
The groin is the fold at the top of the leg, where the leg joins the lower tummy. It is diagnonal, running downwards and inwards. It holds lots of tendons, tubes of blood, a bunch of nerve cables and small lumps called lymph nodes. There is one on each side. Girls have groins too. A ‘groin strain’ is a pain from overstretching the muscles in the groin area.
The testicles are the ball-like things in the scrotum (also called ball-bag, no surprise there). The testicles are very, very sensitive and a thump in the testicles is very sore indeed. For some strange reason, when a man sees a colleague collapse in pain from such a thump, he – the first guy – smiles. I don’t know why this is, but we all do it, even the nice guys. Girls don't have testicles.
The words are straightforward, easy to pronounce and not at all rude. So commentators – let’s hear them.
That said, I remember the great rugby commentator Bill McLaren, describe an incident when a huge Welsh forward was changing his torn shorts at Cardiff Arms Park. His teammates gathered around him, for modesty, or as Bill said “So that he wouldn’t frighten anybody.”
The groin is the fold at the top of the leg, where the leg joins the lower tummy. It is diagnonal, running downwards and inwards. It holds lots of tendons, tubes of blood, a bunch of nerve cables and small lumps called lymph nodes. There is one on each side. Girls have groins too. A ‘groin strain’ is a pain from overstretching the muscles in the groin area.
The testicles are the ball-like things in the scrotum (also called ball-bag, no surprise there). The testicles are very, very sensitive and a thump in the testicles is very sore indeed. For some strange reason, when a man sees a colleague collapse in pain from such a thump, he – the first guy – smiles. I don’t know why this is, but we all do it, even the nice guys. Girls don't have testicles.
The words are straightforward, easy to pronounce and not at all rude. So commentators – let’s hear them.
That said, I remember the great rugby commentator Bill McLaren, describe an incident when a huge Welsh forward was changing his torn shorts at Cardiff Arms Park. His teammates gathered around him, for modesty, or as Bill said “So that he wouldn’t frighten anybody.”
Tuesday 27 February 2007
That Wonderful Rugby Match, and John Terry's Head
I really want to write about the Ireland-England rugby match of last Saturday, but apart from a few comments on Brian O’Driscoll’s hamstrings there isn’t much of medical interest there. (I could indulge in lots of gloating about the victory, but that wouldn’t be my style.) (Snigger.)
The dreadful head injury that John Terry suffered in Sunday’s Carling Cup final gives more scope for medical musings. For those of you who didn’t see it… Terry was attacking, in a good scoring position and launched himself head first at a cross from the wing…and connected full on with Abou Diaby’s boot. There was no foul play, just one head and one boot going for the same ball.
Terry fell to the ground and lay motionless – truly flaccid, not in that silly way some players do when their hope for a free kick is much stronger than their acting ability. No, Terry was knocked out. What we saw next appeared a model of good practice in dealing with a collapsed patient.
The players called for help; the paramedics saw their patient was unconscious and made sure his air tubes were clear – on TV you could see one of them holding the patient’s jaw forward* – then they checked for breathing and a pulse in the neck. Next they made the sensible assumption that there might be a neck injury too so they didn’t use the ‘recovery position’ but held the jaw forward and fixed their patient’s neck in a splint; and added some oxygen reduce the possibility of brain injury. Finally off to hospital.
Could we do the same?
First-Aiders know that the steps for management of a collapsed patient are now standard throughout Europe. There are two ways – the right one and the others. Whether your patient has tumbled from a horse Rathlin Island or from a bus on the Champs Elysee, the procedure is the same. The Resuscitation Council has a good website - See http://www.resus.org.uk/SiteIndx.htm - and here’s a summary: I remember it as Dr ABC
1. Danger! Is it safe to approach your patient? Traffic? Fire? Bare cables?
2. Response; shake your patient by the shoulders and ask “Missus, are you alright?” (If you ask John Terry this and he doesn’t thump you…he’s not alright!)
If no response – Get Help. Don’t be shy. Raise one hand and shout “I need help here!” Send someone to ring 999. “There’s a collapsed patient at…”
*3. Airway; the air tubes are mouth, nose and throat. Are they clear? Look and see. If there’s food, hoke it out. The famous ‘swallowing his tongue’ really means being so knocked out that the tongue falls backwards and blocks the throat. To avoid this, push the jaw forwards from behind, or just pull the jaw up by the lower teeth.
4. If your patient is Breathing, roll him into the Recovery Position, on his side/tummy. If not, you’re into resuscitation measures – you have learned these, haven’t you? If not – back to the first-aid book or website for you.
Like John Terry, you just can’t tell when these skills might be useful. Learn them today.
And like John Terry, your patient may benefit from proper on-the-scene care, and be up and about in no time. Best Wishes to John for a full recovery. (Even if he’s not an Irish rugby player; did I mention the rugby match?)
The dreadful head injury that John Terry suffered in Sunday’s Carling Cup final gives more scope for medical musings. For those of you who didn’t see it… Terry was attacking, in a good scoring position and launched himself head first at a cross from the wing…and connected full on with Abou Diaby’s boot. There was no foul play, just one head and one boot going for the same ball.
Terry fell to the ground and lay motionless – truly flaccid, not in that silly way some players do when their hope for a free kick is much stronger than their acting ability. No, Terry was knocked out. What we saw next appeared a model of good practice in dealing with a collapsed patient.
The players called for help; the paramedics saw their patient was unconscious and made sure his air tubes were clear – on TV you could see one of them holding the patient’s jaw forward* – then they checked for breathing and a pulse in the neck. Next they made the sensible assumption that there might be a neck injury too so they didn’t use the ‘recovery position’ but held the jaw forward and fixed their patient’s neck in a splint; and added some oxygen reduce the possibility of brain injury. Finally off to hospital.
Could we do the same?
First-Aiders know that the steps for management of a collapsed patient are now standard throughout Europe. There are two ways – the right one and the others. Whether your patient has tumbled from a horse Rathlin Island or from a bus on the Champs Elysee, the procedure is the same. The Resuscitation Council has a good website - See http://www.resus.org.uk/SiteIndx.htm - and here’s a summary: I remember it as Dr ABC
1. Danger! Is it safe to approach your patient? Traffic? Fire? Bare cables?
2. Response; shake your patient by the shoulders and ask “Missus, are you alright?” (If you ask John Terry this and he doesn’t thump you…he’s not alright!)
If no response – Get Help. Don’t be shy. Raise one hand and shout “I need help here!” Send someone to ring 999. “There’s a collapsed patient at…”
*3. Airway; the air tubes are mouth, nose and throat. Are they clear? Look and see. If there’s food, hoke it out. The famous ‘swallowing his tongue’ really means being so knocked out that the tongue falls backwards and blocks the throat. To avoid this, push the jaw forwards from behind, or just pull the jaw up by the lower teeth.
4. If your patient is Breathing, roll him into the Recovery Position, on his side/tummy. If not, you’re into resuscitation measures – you have learned these, haven’t you? If not – back to the first-aid book or website for you.
Like John Terry, you just can’t tell when these skills might be useful. Learn them today.
And like John Terry, your patient may benefit from proper on-the-scene care, and be up and about in no time. Best Wishes to John for a full recovery. (Even if he’s not an Irish rugby player; did I mention the rugby match?)
Thursday 22 February 2007
There Can Be Humour in Death
An average General Practitioner looks after about 1800 patients, and of these about 12 die each year. Some die at home, some in hospital amd hospices, others out and about in other places. I suppose most of would like to die at home in the company of our loved ones but that isn't always easy to arrange...
I have been working in my local hospice recently and have been touched by the strength and humanity of many of my patients there, all of them knowing that their deaths are not far away. I was particularly entertained by a story from Bobby, who was well enough to enjoy his 80th birthday but died some days later.
Bobby had worked for a time as an undertaker's assistant, and as he noted that it might not be long until he was in the hands of the undertaker himself he remembered being a young man going to a house to lay out the deceased. It was the nineteen forties and there was no electricity, so he brought his candle for light. As he worked at the final dressing he accidentally pressed on the deceased's tummy; this expelled some retained air from the lungs and blew out the candle...
Some time later his colleagues went to find out why Bobby was taking so long... they found him in the dark, still fainted, lying face down across the legs of the deceased! Fainting seemed reasonable enough to me - I wonder how I would have reacted if I felt the corpse had blown out my candle?
Bereavement and grief are very powerful emotions; many of us have experience of the severe pain from the loss of someone we love. Here in Northern Ireland we help one another through this pain with our funeral procedures. We have the custom of the wake and the church service followed by the burial - or more recently, cremation - and it is understood the process takes three days or so. It's not the same in England, where the funeral is often held a week, even a fortnight after the death.
I was reminded of this twice recently - once when an Englishman domiciled here for thirty years died and his sister who had never been to Northern Ireland had come over to be with him. She was astonished - and delighted - at the social support she and her brother had in his illness, and then for the funeral. She couldn't believe how smoothly the arrangements could be made and how many people came to pay respects.
The second time was when I attended a talk by the Coroner for Northern Ireland, Mr. John Leckey. John was explaining that there are new arrangements for the signing of death certificates, and he felt he would have great difficulty applying them to Northern Ireland. "They may well work in England, but maybe not here" he felt.
The new stuff follows from the report on the infamous Dr Shipman - more about him shortly - which demands more checks and cross checks on the death certificates doctors issue. These checks will take time and may delay funerals. The custom of the three-day funeral is so embedded in us that we won't want to delay matters just so the coroner can get the paperwork done (even if the paperwork is really to protect us all from another Shipman)!
Shipman was such a devious character that I think even he would be able to get around the new checks, but let me wait until the new system is in place before discussing it fully.
By the way, do you remember the initial reaction to the Shipman accusations? A group of his concerned patients began a group in support of him, unable to believe such a 'fine doctor' could be accused of mass murder. The group disbanded as the evidence mounted - for example his practice had many, many more deaths per year than the average twelve I mentioned at the start. Later one of the group commented: "He seemed such a good doctor in every way. He was available to speak to, spoke to me without jargon, seemed caring and concientious. Except he murdered my mother." Makes you think, doesn't it?
But Shipman was a rarity. There some forty thousand GPs in the National Health Service, with very few bad ones. That's thirty nine thousand and many hundreds of good ones.
I'll write about how we test the good ones another day.
I have been working in my local hospice recently and have been touched by the strength and humanity of many of my patients there, all of them knowing that their deaths are not far away. I was particularly entertained by a story from Bobby, who was well enough to enjoy his 80th birthday but died some days later.
Bobby had worked for a time as an undertaker's assistant, and as he noted that it might not be long until he was in the hands of the undertaker himself he remembered being a young man going to a house to lay out the deceased. It was the nineteen forties and there was no electricity, so he brought his candle for light. As he worked at the final dressing he accidentally pressed on the deceased's tummy; this expelled some retained air from the lungs and blew out the candle...
Some time later his colleagues went to find out why Bobby was taking so long... they found him in the dark, still fainted, lying face down across the legs of the deceased! Fainting seemed reasonable enough to me - I wonder how I would have reacted if I felt the corpse had blown out my candle?
Bereavement and grief are very powerful emotions; many of us have experience of the severe pain from the loss of someone we love. Here in Northern Ireland we help one another through this pain with our funeral procedures. We have the custom of the wake and the church service followed by the burial - or more recently, cremation - and it is understood the process takes three days or so. It's not the same in England, where the funeral is often held a week, even a fortnight after the death.
I was reminded of this twice recently - once when an Englishman domiciled here for thirty years died and his sister who had never been to Northern Ireland had come over to be with him. She was astonished - and delighted - at the social support she and her brother had in his illness, and then for the funeral. She couldn't believe how smoothly the arrangements could be made and how many people came to pay respects.
The second time was when I attended a talk by the Coroner for Northern Ireland, Mr. John Leckey. John was explaining that there are new arrangements for the signing of death certificates, and he felt he would have great difficulty applying them to Northern Ireland. "They may well work in England, but maybe not here" he felt.
The new stuff follows from the report on the infamous Dr Shipman - more about him shortly - which demands more checks and cross checks on the death certificates doctors issue. These checks will take time and may delay funerals. The custom of the three-day funeral is so embedded in us that we won't want to delay matters just so the coroner can get the paperwork done (even if the paperwork is really to protect us all from another Shipman)!
Shipman was such a devious character that I think even he would be able to get around the new checks, but let me wait until the new system is in place before discussing it fully.
By the way, do you remember the initial reaction to the Shipman accusations? A group of his concerned patients began a group in support of him, unable to believe such a 'fine doctor' could be accused of mass murder. The group disbanded as the evidence mounted - for example his practice had many, many more deaths per year than the average twelve I mentioned at the start. Later one of the group commented: "He seemed such a good doctor in every way. He was available to speak to, spoke to me without jargon, seemed caring and concientious. Except he murdered my mother." Makes you think, doesn't it?
But Shipman was a rarity. There some forty thousand GPs in the National Health Service, with very few bad ones. That's thirty nine thousand and many hundreds of good ones.
I'll write about how we test the good ones another day.
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