Dementia

Average survival predicted ten years and you have early stage....that was four years ago

My sixteen year old daughter summed it up nicely

The great thing about Jido is every time we see him it is like groundhog day, he asks exactly the same questions, and you get the chance to answer them ever so slightly differently until you find the answer that makes him happiest

Belated knowledge

Not my usual day I must be honest

I received the email last week, and couldn't really argue; it was true the patient was a lot closer to us than to he hospital that had been advising on her blood results recently, yes of course we could take over, this was expected to be a short-term situation until the patient could be moved closer home.

The patient was non-resident, she had arrived by plane, taken a train to central London and then presented to accident and emergency and had been in one hospital or another for the past four week.

I had planned on seeing her on the ward round, yesterday frantic emails about deterioration etc made things more pressing and so this afternoon with my trustee trainees we went on a visit.

Just across the road from our "home" hospital, across the car park and into the two storey building.

I guess I should have picked up the cues but just thought it odd that we had to be buzzed in, not only the main entrance but at every step of the way, through reception one door closing before the other opened, up one flight of stairs to another locked door and then we had arrived.
Corridors with a faint urinal smell, a hush broken by the young woman in pink leisure suit with headphones cursing loudly

After an initial stutter we explained who we were and who we had come to see, a nurse said she would find her for us

A tall skinny woman a few months my senior, dressed in a loose top and tight skirt, her long hair tied into a loose bun falling slightly off centre came walking down towards us.
Introductions followed a detailed history in the corridor, the history was longer than I had appreciated, I expect she had had several years of treatment interrupted probably several times, she told me she had started but not completed medical school, and clearly had the vocabulary, mostly she seemed coherent, with the exception of some almost obsessive repetition of what she felt had caused her leukaemia; namely the food and pollution, well a fair number of people do believe that, so far so regular, she understood about targeted therapy, and transfusion triggers, but was cagy when asked about where she had been staying in London, and who was back home.

Can I examine you? I ask, of course she responds and we traipse back down the corridor to her room, she unlocks the door and invites us in, my trainee stands at the door, I am not sure that is necessary but she insists
I examine her lungs which are clear, her legs swollen and tense, her spleen about 7cm below her rib edge.

We continue talking, and she is now repeating herself, we are talking about minerals and fluids, and diet and snippets of history it is becoming a little less regular as she describes the ambulance personal as white faced with hair that changed on route, and empty eye sockets.

She reaches out to my arm and declares You are human, you know not everyone here is.
I extract myself and bump into a nurse passing by, are you alright she asks? I think so I respond, but your patient is talking about feeling suicidal if she is kept locked up.

The nurse escorts us back to reception and after closing the door asks, do you have self defence training? No? did you have an escort? No? do have alarms on you? No?. This is becoming stranger by the minute.

Apparently our patient with leukaemia has a history of physical violence against staff and is approached with care.....we must ask for an escort in future....and never enter the room alone!

Weekly ward rounds are suddenly so much more interesting

Downhill 30 years a doctor

Well in the summer of 2018 it will be 30 years since I graduated.

Strange how entire weeks and months of our lives merge into sludge, but certain minutes or hours are seared into memory. I remember the day still, walking to the university in light purple sandals, and a dusky pink skirt. The mass of people in the deanery trying to find names on the paper lists pinned to the dusty cloth behind the glass screen. Someone congratulating me before I had reached close enough to see, then another and finally seeing for myself, my name at the very top of the list of graduates for the year.

I was walking on a cloud, and didn't really want to go home as I basked in the warmth of the sun and of my success.

Many miles away in a war-torn city my father was distributing fruit squash and sweets.

That evening my mother took me out to a smart part of town and I remember thinking I have done it I have won.

I am clearing out the loft conversion into which we moved, when my sick mother came to stay just before her surgery, and this week I have at last discarded the graduation photo, it was creased and in one corner torn, but the final decision to discard it was made easier as I looked through the faces trying to remember more than a handful of names.....

As we go through the third round of "should I go or should I stay" as both my husband's and my hospitals are both being reshaped by the financially more secure / militarily supported establishment that took them over, and the original team are pushed ever so not gently out of the way, I start to update my CV, thirty years a doctor, fifteen of which I have spent here, and what do I have to show for it? very little it would seem. Fifteen years of gradual decline, gradual loss of specialism and with that expert staff, and a shift from numerous conditions treated, several trials open, and shared care that means we provided some of it in house, to a second rate general dumping lot for conditions other aren't interested in, a median patient age of 75, and I find myself trying to figure out how to publish experience that isn't even really my speciality it is so generic.

I guess the only consolation is that with a cohort of over 400 graduates distributes over every continent in the world, there are never any reunions.