The Life of a Junior Anaesthetist

Online identity

2011-02-27T07:25:00.001Z

It's interesting to think that millions of people worldwide can have access to the things I write within a few clicks of a mouse. I often wonder whether the things I can say are all that interesting.

Twitter has exploded of recent years, and micro-blogging has really taken off. I recently got retweeted by Kirstie Allsop (off the telly) when I offered advice to women about emergency cesarean sections, and wondered then about the legalities of an online presence. A friend once pointed out the possible consequences of being too open online, too much information can easily lead to patient identifying information and their confidentiality can easily be breached. This of course would be unethical, and bad for patient care, and there is a risk to my professional career.

I have seen recently a few examples of when colleagues and friends get a bit too close to this, and it is occurring more frequently. Over the last few years hospital Trusts have started including social networking policies in their guidance and have started to ban he uploading of pictures of the workplace, especially of staff or patients, no matter what the context.

So although my work life is incredibly interesting and exciting, it's also a big secret for the online community! My warning to my friends and colleagues online is to be mindful of your online presence, that what you tweet/facebook becomes the permanent property of someone else, and you may give away more of yourself than you mean to. It is certainly not worth your career, unless you can make a mint out of blogging!

New one on the way, head injury and trips to IKEA

2009-11-22T22:17:00.002Z

I've been asked recently why it is I have been tweeting so much, but not writing on my blog. I guess they are the same thing really, especially seeing as my tweets can be found in the sidebar of this blog. Also, it takes only a few seconds to use Twitter, but it takes a wee while to sit down and write a blog article. For example, the time that I'm using to type this should really (in the eyes of Mrs. G.) be being used to erect the nursery furniture we just bought from IKEA.

That's right, there is another baby on the way, I don't know if I mentioned that before, but he is nearly here. It has been a rocky road, like before, but there is light at the end of the tunnel. Mrs. G is 36 weeks today and the bump would no longer really be premature should he make an appearance. This is good, as he looked like he was coming two weeks ago! We were due to go to Center Parcs for the week, and on the Saturday Mrs. G started contracting 3 in 10, fairly strong and we had to go to the delivery suite. Luckily it was where I had worked before and they got the registrar to see us straight away without having to be seen by an SHO who no doubt would have been a GP trainee with no interest in O&G. A quick 'fibronectin' test later and we were assured that bump would not be coming for at least two weeks. Nice.

We had a great time at Center Parcs, as usual. We went to the Sherwood Forest one again, and stayed in a villa next door to the swimming pool. There is always a difference in family dynamic everytime we go to CP, there is usually someone different with us and this time it was the bump. Mrs. G couldn't go on any of the fun slides, but made it a couple of times down the big tube ones. Josh however wanted to go on everything, which he managed all except the Rapids, he isn't really a strong enough swimmer to manage that one. That said, Josh has excellent form when it comes to swimming strokes, and his armbands are probably not that far from coming off. I've attached some CP pictures to this article.

Yesterday I had a real injury! I was in the lounge, we'd had a fairly lazy day sorting things round the house, an I went to lie down backwards on the new carpet. BAM! I hit the back of my head really hard on the oak nest of tables I got Mrs. G for Christmas. Ooooo, the pain. I couldn't bear to move for a few moments, but once I realised I could still see and move I went to assess the damage. My family were with me, but I quickly remembered that I was the medically trained one, and they haven't yet been on that first aid course I've been promising to sort out for them! So I sorted my own bleeding head (torrential, needed a gauze dressing and a bandage!) and then came back to clean the blood off the new carpet. Crazy! I was pleased to find myself alive and well this morning, and I'm not sure whether it was me or concussion talking but I agreed to go to IKEA over lunchtime.

We did some last minute nursery furniture shopping, had a good lunch, and my concussion allowed me to spend whatever the number was on the chip/pin machine. Not sure what the total was, my eyes were still a bit blurry! ;)

Bye for now, the wee man wants some grapes!

Yesterday's quirks

2009-07-22T12:41:00.000Z

Yesterday I had two funnies:

One elderly patient who had had some premed came out with "this couple get married and on their wedding night he says 'I'm sorry but I'm built like a baby done there'. She says 'don't worry, we'll get through it'. He drops his trousers, she screams and runs out! She returns trembling and says 'I thought you were built like a baby?' He replies 'yes, 7 pounds and 22 inches long'!

Later in the day we found that a gentleman booked for an ENT case would not get done for a lack of surgeon. We rang down later to make sure the surgeons had told the ward. In the background I hear the fire alarm! The support worker tells me someone burnt some toast. Could I speak more loudly please? I said 'YES! HAVE YOU FED MR. X?' She says 'it was his toast'!

Ace.
Sent from my BlackBerry® wireless device

Waiting for the bus

2009-07-20T16:11:00.000Z

I'm currently in the sunshine waiting for the staff shuttle bus to take me across to the other hospital site to start my oncall duties. I'm probably going to be late, but I'm not stressing too much.

I haven't blogged for such a long time, so there is loads to say. I've been really busy for the last year really. Since passing the final FRCA in June last year I've been getting into prehospital care. I was happily celebrating my success at the pub in Russell square, when my friend and colleague (also just passed) came to me and said I should get on the air ambulance. I was a bit drink by then and thought it a great idea!

So that was it, I've been observing on the midlands air ambulance, and driving around Stoke on Trent on a Friday night with a paramedic for coming up to a year. I've done so many courses I think my brain might burst, all my life support courses and the PHECC (prehospital emergency care course).

I have recently been accepted as a doctor on the north staffs emergency response car and have done two shifts, the first one was ace, with an RTC near Abbots Bromley ending in a helicopter flight. Really exciting stuff. I plan to make that a regular commitment, whilst getting some more observing done on the helicopter. Hopefully I can get flying as a doc from Tatenhill, which is close to my house.

Anyway, the bus is here now, so off to stage 3 of today's activities. Bye!
Sent from my BlackBerry® wireless device

A promotion!!

2008-11-07T13:11:00.001Z

Well, not so much a promotion as extra responsibility. I'm now 3rd On-call at Queen's hospital Burton on Trent. This essentially means that I'm looking after the novice anaesthetist when (s)he's on call, but I'm also an extra pair of hands or a second brain for intensive care and maternity anaesthetists alike.

Yesterday I finished my first week of nights in this new role, and I have to say I thoroughly enjoyed it. I'm told that other 3rd ons have just confined themselves to sitting in the coffee room ready to bail out the newbie in times of trouble. I've never been one to sit still for too long, so I found myself helping out in theatre (the newbie actually told me to sit in the coffee room by the end of the week!), helping to sort out the critically ill folk on the ward with the ITU SHO (who was a non-anaesthetist so needed some extra skills anyway), and even on the maternity unit - they were so busy over the week that I found myself demonstrating labour epidurals to the novice quite a bit! It was great to feel needed by all three members of the team, and I was able to coordinate a little too. I'm sure the consultants felt the benefit, as I was able to keep them in bed all week!

The new job role has been tiring though, and I'm trying to get over a stinking cold, I'm just about there, being able to sleep in chunks longer than 2.5-3 hours has made the difference I think.

The other major change is that I'm now flying with the air ambulance. I'm observing the docs in the prehospital setting in order to go solo and do it myself in the near future. Having missed out on an ED job, and prioritising the FRCA over other qualifications has meant there is a lot of work to do before I can go it alone. I'm spending next week in the ED minors, to learn how to manage fractures and minor wounds, and I've enrolled in all the life support provider courses I can get into - ATLS, ALS, APLS, and MIMMS! So many manuals, so little time!

A beautiful holiday

2008-09-11T21:44:00.000Z

I'm lying in bed at the end of my week in Spain, totally relaxed, having had a tremendous holiday. This is a bit of a test really, I've not tried to write a blog entry on my BlackBerry before.

Anyway, the three of us had a great time, the start of it was with my Mum and Dad, and my Nan, and they really enjoyed seeing Josh on holiday. We decided early on to bite the bullet and put some armbands on him and see what happened. Amazingly enough he just started kicking and got on with it! So now he is capable of two lengths of a rally big pool without help. My boy is amazing me everyday.

Let's hope the flight home is a smooth one and England has dried out a bit!
Sent from my BlackBerry® wireless device

Waiting for the sunshine

2008-08-17T23:50:00.000Z

I always seem to start a blog entry thinking that I haven't written anything for some time, and that I must do it more often. Today is no exception. It's currently 01:35am, I'm sat in the ODP office in Main Theatres, and I'm waiting for the right moment to get some kip. Unfortunately, there is no such time, as being the oncall obstetric anaesthetist means that there will always be a call to do some work right at the moment your head hits the pillow, or worse 15 minutes in so you've just dozed off.

There have been some dramatic changes in my life, partly responsible for the lack of blogging. I spent the last six months of my life with my nose in the books, studying religiously for the final FRCA examination. I finally took the last part of the last exam at the end of June, and passed! Good grief though, it was a tough exam. I felt during the vivas as though I was making up the answers as I went along, good job I made sense I guess. Some of my colleagues were not so fortunate and have been left in this state of limbo - knowing that they will have to continue working that hard for the next few months until the next exam, and that they will not have their lives back for some time yet.

My life however, is fully restored to me. It's wonderful not having to feel guilty about spending time with my family, I'm reveling in the summer that might not have been. In case I didn't mention it before, I'm back in Burton on Trent hospital again, and it has been great to see all the friendly faces there again. Not much has changed, and it has been easy to settle into the old routines again. Unfortunately the pace has quickened significantly in this once-sleepy burrow, and there is more than enough work to keep us all busy! The maternity unit has gone for taking about 3500 deliveries a year to well over 4000! The epidural rate seems to have gone from 25% to close to 50%, and the cesearean rate is increasing too. The hospital has been getting some very good word of mouth recommendations, and with the implementation of patient choice, we are getting parturients from all over the region choose to deliver at Burton.

There is an important decision looming over the family at the moment. It is an age-old decision that countless millions of families have pondered through for centuries. It is such a fundamental decision that the rest of our lives depend on it, and there is a finite time period in which to decide.

Baby or Rabbit?

Man, I wish I knew the answer. Only time will tell.

Parental Responsibility

2008-04-03T12:41:00.001Z

Woah, I've finally been given the whole day to look after Josh on my own... It's a frightening prospect, but it's going OK so far. I've been given a day's reprieve from revision and work, to look after the little man, but he's having a nap and I'm free to write something on my much neglected blog!

What to say?? Well, things are going exceedingly well at the moment, even if life is hard work. I'm still at Stoke on Trent (University Hospital of North Staffordshire), but will be returning to Burton on Trent next month - Hooray! No more driving for two hours a day! It'll be nice to see everyone again, but at the same time it will be different now that I'm a registrar.

The exam is looming close now, it's in less than three weeks in fact, the written part is on the 22nd April. FRCA revision is tough, it's difficult to know what to revise seeing as the test is on the whole spectrum of anaesthesia. Also, it's important to be up to speed on latest developments as well as having read the textbooks. Man!

I've been working like a dog for the last few weeks, lots of oncalls, getting my modules signed off, etc, so that I can have these next three weeks off to study - so what do I do with one of the first days? Have a day off... Oh well, I don't get to see my son anywhere near enough, so we went to the library, to the park, to the playground, to the shops, and that was only the morning! I think after lunch we will head off to the farm park, and see some chickens. Ace.

2.5 years of Anaesthetics, 1 year of Fatherhood

2007-08-23T11:06:00.000Z

I can't believe it. I've just checked to see when I wrote my last blog entry and it turns out to be well over a month ago. OK, need to set this straight.

Distractions have obviously outweighed computer time recently, there has been a fair amount going on. Rachel is well, having survived yet another round of redundancies at her work; but she has had to take a new job which involves a move to a new building on the other side of town. Now Josh's nursery seems a bit of a long way round, but he's very happy there, and we like it.

Speaking of the little man, he's had his 1st birthday! Hooray! It was great fun, we had a wonderful time; we had lots of family and friends round and there were loads of cool new toys for me (Ahem, I mean Josh) to play with. He especially loves the new ball pool and the sandpit - I remember when I was little and had great fun with these things, and now I get to play again! Cool! Within the two weeks spanning his birthday he learned to walk. He is now following us about the house, wanting to play and bringing us toys. It's brilliant!

I have done my ITU module, prolonged a few more lives for a bit, and have returned to Anaesthetics. I've moved straight on to a Paediatric module, so I get to play with toys at work as well as home! It has been good to get some more experience with the little ones, they seem to be regarded as a specialty in their own right, and as such we don't get that much exposure to small people. I've learned some neat tricks - such as intubation in a spontaneously breathing person with lignocaine and a mucosal atomisation device (sounds more complicated than it is!).

The trainees have been saying for some time now that they are unhappy with the amount of training we have been receiving. We have also just had a new rota which should make us EWTD compliant and work less than 48 hours per week. However the rota is designed for 36 people and there are only 32 of us (2 short and 2 on maternity leave). I've decided that the time has come to sort it all out once and for all. We obviously need some proof of our training provision and hours compliance so I've arranged to audit both during an Hours Monitoring Period. It will be interesting to find out whether we actually are being screwed or if we are all just moaning too much!

Having been sailing a few more times recently, I've started to get the hang of it. I went out yesterday with my Dad, and helmed for a bit in a blustery environment where the wind went round in circles in certain parts of the lake. Very complicated, and regularly stranded, but we had a good time.

So that's me. I could probably say lots more, but seeing as this blog never gets read, (apart from my Pain relief in labour article) I should probably go and gas some poor kids while a dentist rips their teeth out.

Be good! BTW, good luck to Tamsin who might come by to read said pain relief article as it might be important for her soon!

My calendar

2007-07-16T17:27:00.000Z

My Current calendar for those who need/want me:
It should stay up to date so check here when planning fun times!

Click here!

Dangerous Dave's Dancing Masterclass

2007-06-03T20:27:00.001Z

OMG, my brother in law seems to be some sort of android, he has got some crazy moves!

Zaiti's mention

2007-05-30T11:34:00.001Z

Zaiti (a recent commentor on this blog, my friend, and an SHO at work who has far more ITU experience than me is a regular blogger.

She ponders life and death, her life, her death, and her career. A deep (and shallow at times) account of such wonderings is found at http://zaiti.spaces.live.com

Of course no blog entry is complete without a picture or two, and seeing as I have no pics of Zaiti, I'll make you all go ahhhh by showing you this weeks favourite Josh pics - He was 10 months old yesterday! Incredible how time flies!

The Christening!

2007-05-18T13:12:00.001Z

It was Josh's christening a couple of weeks ago, and we managed to find him the most embarassing outfit you have ever seen (unless you've been to a christening before in which case all the babies look like that!).

It was a lovely day, the sun came out and everyone had a great time. We invited everyone back to our house for a buffet, it's the fullest I've seen our house so far, good job people could stand in the back garden too!

There are loads more photos at picasaweb, so take a look!

Viral sharing

2007-05-18T13:06:00.001Z

Sorry, a lame effort at a geek joke. Since Josh went to nursery, we have been showered in gifts from the other kids. Rhinitis, tonsilitis, otitis, conjuntivitis, myalgia, fevers, and migraine. Very generous. I'm currently at home having just about recovered from the last virus. This one was a doozy! I thought it was just a cold, but then came the sore throat, and full head with deafness. Then the headaches, and muscle aches. I struggled on working on the ICU until two days ago convincing myself I was at the tail end of it all, but when the migraine came I had to stay home for two days. Ouch.

I'm not sure that these illnesses are worth £50 per week.

;)

The Lion and the Lip

2007-04-15T10:34:00.001Z

The Lion and the Lip
Originally uploaded by mikegreenway.

Couldn't resist posting this one, it feels so warm and sunny. BFN!

A busy week

2007-04-09T21:18:00.001Z

Another week is over, it's the weekend again and I am feeling pleased that I might have helped some people and expanded my repertoire. I got to help on some complicated emergency cases, and also work with my old '3rd On' from when I was a novice. It was great to see her again, I kept trying to point out skills I have picked up in the last two years, only for her to keep saying "I do it like that". DOH! What have I learned in the last 21 months since she left??

Easter has been and gone, and the holiday was horrible. I finally get a consecutive four days off, and Josh brings home two or three viruses home from nursery. A horrendous cold, and sever D&V that makes you drier than a dessicated coconut before putting you off chocolate eggs for a fortnight! Oh well, they were probably bad for me anyway, plus I get to miss a day's work and stay home during my quarantine period. Why is it that we only get ill during weekends and holidays?

Been out and about with the camera again:

I'm really enjoying this new camera, it has made me start looking at the world in new ways.

I'll be starting my Junior SpR intensive care module when I go back to work next week, 3 months of continuous service in ICU, hope I remember how to gas people when I come out the other side!!

TTFN

First week over

2007-03-11T07:45:00.001Z

Well I never, the first week as a SpR was indeed the same as the last week as an SHO. It wasn't a life-ending transition with people asking me to make life/death decisions left right and centre! I did manage to show my true colours a few times without being underestimated beforehand which was nice, but at the moment my newbie status is advertised by the white sticker on my ID badge with a handwritten "SpR" on it!!

At home, I've had a great weekend, we just bought Josh a swing for the garden since the sun is coming out a little more often. Tried it immediately despite the cool breeze, he won't thank us for protecting him with that hat!

Between Jobs

2007-03-03T21:01:00.001Z

That's right, the time has finally come! I finished my last on call shift a week last Sunday as an SHO, and will return on Monday as a Specialist Registrar. It certainly sounds good, and I'm still having a little trouble getting to grips with the idea!

A good plan though was the 10 day break in the Lake District. We took Josh, and settled in at the flat. We tried to get as many walks in as possible, but the weather was against us!

Of course we got to try out the best in walking gismos, a baby backpack - an excellent gift that my Uncle David had bought for Josh when he was born. We had thought he would never fit into it, it looked so big at the time.

We couldn't have Josh not pulling his weight though, so he did his fair share!

Plenty of trekking and climbing done, we have worked our gluts to the bone. Rachel did some mountaineering of her own!

We have come back feeling very well rested and I'm hoping that next week will be something to look forward to.

SpRland here I come...

2007-02-10T15:23:00.000Z

So! I guess you could say that I'm one of the jammiest around, but I would of course like to think that skill and/or charm had something to with it! With only one application form filled in, I got an interview for an SpR rotation, went to it and got the job. Not only that though, I got my first choice of school too, Stoke on Trent. This means that all the hospitals within the rotation are within an hour from my house. Couldn't be better.

I've amazingly managed to catch up my career progression to the fastest possible again, so hopefully I can maintain that next year and get my Final FRCA this October (D*mn though, that means I'll have to get back to the books! My new job starts on the 5th March 2007, so we're taking a couple of weeks off between grades to go to the Lake District again.

In the mean time, we've been making snowmen and having snowball fights!

There's an evil Santa!

2006-12-22T13:44:00.001Z

OMG, I just found out there is an evil santa! You can find him at http://www.lettersfrombadsanta.com/ He makes toys like:

and

I hope the good one comes to visit me this Christmas! Merry Christmas everyone!

Mike

Road Tax Prorated

2006-12-05T13:01:00.001Z

With recent news that the latest in transport taxation is to charge per mile with varying costs to dissuade the public from travelling at peak times, I am concerned for the health of the nation and the spiralling costs for the NHS. As a junior doctor training in the NHS I am sure that leaving work early to avoid the weighty tax fine will be frowned upon and so will be staying late to stay in the black. My on call colleagues will be quite happy for an extra pair of hands for another hour or two each evening, but at what cost?

Hours monitoring will undoubtedly prove that my rota is no longer compliant with EWTD, and I shall involuntarily drain the NHS coffers at Band 3. So we all do this and the Trust becomes badly hurt.

Now I’m not getting home to my wife and son until after his bedtime and he gets abandonment issues, perhaps sparking some child psychiatric issues, so we take him to the Trust psychiatrist and drain some more resources. I’m getting pretty tired and run down so I’m taking more sick days. I’m covered by expensive locums and the NHS becomes almost bankrupted.

But it’s not just my job, my career, my colleagues. What if everyone stays at work an hour later, or makes a habit of stopping at the pub waiting for the peak time to be over. We all go home at seven o’clock and roads are jammed. We all get detached from our home lives and stay late at work. Depression and ill health rockets, the pub-goers have more accidents. Where will our over stretched NHS be then? Can we fund the deficit from the people who are still going home to see their families? Are they the richer folk who can afford the luxury of spending less time at work and more time at home? Is the government making a judgement that the poorer working classes ought to be at work longer and not making lasting relationships with their children, helping them to fight off the temptation of becoming ‘hoodies’?

After spending a half hour pondering the effects of altering road tax, I can foresee a nation of maladjusted youths who grow into a life of crime or workaholism, never see their kids, get depressed about it, resort to bad habits that make them unwell and bankrupt our health service. Perhaps altruism has its place after all.

First week in Stoke

2006-12-04T06:00:00.000Z

OK, so it's not that bad. In fact, it's been a good start to a new job. I've discovered that there are some untruths circulating about Stoke hospital and the Potters. The people do smile at you in the corridor, and you do get some time to write your blog.

City General Hospital - Stoke on Trent

After starting here I was given the first weekend night shift possible, so had to know my way around the hospital before the arrest bleep started going off! There have been a few trauma cases, and a few ITU admissions, a few arterial lines and a few central lines to get me started, and it has been a pleasurable experience.

Home life is a little bit tougher, the extra hour and a bit's commuting gets me home later, closer to Josh's bedtime, so I'm getting fewer cuddles now. One of the most noticeable things about working nights in a busy hospital is having to stay up all night, and actually go to sleep in the day! Monday was a tough one, trying to convert back to days in one day is tough stuff - I just stayed up for 26 hours and had a good sleep.

If I thought that life was going to calm down for a bit, I was wrong. Although I've got the exam, a few audits under my belt and just have to wait until March until I'm eligible for an SpR job, I do actually have to find said employment. I guess I had assumed that I would be forced into the melée to find ST3 work next August - but against the odds I've been shortlisted for an SpR interview next week. These interviews are renowned for being tricky to say the least. I'll have to brush up on all the hot topics of the moment to see if I can scrape through. Wish me luck!

Last Day at Burton

2006-11-21T21:43:00.000Z

I sit here, in the coffee room on Delivery Suite waiting for either an emergency delivery or the opportunity to relieve a desperate woman's labour pain, and reflect on the last 20 months I've spent at Queen's Hospital, Burton on Trent.

I do this because my time here has come to an end. After a late night discussion with one of my Specialist registrar colleagues, I realised that it probably was time to move on to a more complicated, high-paced workload. A pity really, because this place has really suited my Type-B personality.

Since joining Burton, I've moved from a complete novice in Anaesthesia, to being proficient in most areas, and am trusted enough by the bosses to provide Obstetric anaesthetic cover here out of hours. I'm honoured to be honest, to be allowed input for the happiest place in the hospital.

Unfortunately, moving to a new place means being untrusted for some time to come, until my skills have been 'felt out', and I'm allowed to regain the confidence of my new colleagues. I'm moving to the University Hospital of North Staffordshire, in Stoke on Trent. I'm told that it's a large hospital, where no one knows each other, you don't get looked in the eye in the corridor, and you rarely get a break, let alone lunch. I sincerely hope that there has been some reporter bias, and the outlook is not quite that bleak!

The move might provide me with the little extra star for my CV to help me get onto the nightmare Specialist Training rotation (see previous post). I will get much more exposure to Trauma, and other more complicated methods of anaesthesia - Cardiothoracics, MaxFax, Neurosurgery, etc. Even the run of the mill stuff can be more complicated. There will no longer be a cap on the how young a child I can gas (previously 5 years). All in all, this place frightens me to the back teeth.

So, looking back at the people I've helped here in Burton, and the wealth of caring and generosity I have received from the staff I realise just how fortunate I have been. Not only did the job come along just at the right moment, when I had no job, and allow Rachel and me to start thinking about starting a family, and provide me with the start in the career I have always wanted, but it has also brought me close to so many people whom I feel I can call friends.

I dearly hope to keep in touch with so many of these wonderful people, and hope to return to them as soon as possible, but I know that realistically, there is a chance that many I may not see again, and this brings a pain to my heart, and a tear to my eye.

Pain Relief in Labour

2006-08-23T17:52:00.000Z

Written for www.mumsandbubs.co.uk

Many women are frightened of labour and childbirth, everyone knows of a horror story where labour went on for three weeks, where the pain was constant throughout, and was like being burned alive. Chances are, it won't be quite that bad.

50% of women interviewed after delivery in a recent study said that their pain had been severe or very severe, so it's worth taking seriously and investigating the options for analgesia (pain relief). Primips (women with their first baby) are more likely to experience pain than multips (had one or more already). Babies who are not in the ideal position (e.g. back to back / cheek presentation) will cause more pain. Obstructed labour is more painful than normal labour.

Psychological factors:
Studies have suggested that women entering labour with the right frame of mind can experience less pain, having a supportive birth partner (women better than men), and knowing that labour will only last a finite amount of time can help. Unfortunately some women believe in the power of the mind to such an extent that they are expecting painfree labour - only to lose all self-confidence when it does hurt, making it hurt more.

Position:
During pregnancy you are told not to lie flat on your back, for reasons of aortocaval compression - your baby's weight will compress your major blood vessels, and can compromise the baby or make you dizzy and light headed. However, the most convenient (for the midwife) position for delivering your baby is flat on your back with your legs in stirrups! This position is possibly the most uncomfortable way to push and used to be encouraged, but more recent thinking allows for all manner of manoevures. The most natural position is probably on all fours, or squatting. These two are associated with less pain, so there is some benefit to remaining mobile. Many women find that a warm bath, or the water birth pool can be very effective at reducing pain.

TENS:
Transcutaneous Electrical Nerve Stimulation (TENS) is a device which attaches to your back. Tiny electrical impulses are passed between two/four/six electrode pads, which are stuck either side of your spine. The idea is to make some of the nerves going into your spinal cord fire impulses to the brain. These nerves would normally carry 'touch' information. 'Touch impulses' takThis is a super-charged version of having your partner rub your backe priority over 'pain impulses' which are carried by different nerves. The pain sensation is blocked on the way to the brain, so pain relief is acheived. This is a super-charged version of having your partner rub your back. Be aware that some hospitals require you to book a TENS machine in advance, so check with your midwife.

Non-invasive analgesia:
The only drug analgesia available without needles is paracetamol and entonox ("gas and air"). Paracetamol can of course be used without the need for monitoring, and can be quite successfully taken in early labour. Make sure you do follow the dose instructions on the packet if you are taking it at home.

Entonox is a gas mixture of 50% Oxygen and 50% Nitrous Oxide ("laughing gas"). It is an excellent pain relieving agent, and is breathed through a demand valve system. Most delivery suites have it piped through the wall, some have it straight from a bottle. When breathed deeply over several consecutive breaths, the level in the blood quickly increases. This level is directly linked to the amount of pain relief.

It is important to realise that there is an interval between starting to breath the entonox and getting pain relief, otherwise you will start breathing the gas too late, the contraction will hurt, and then you'll get dizzy, light-headed, and giggly after the contraction has faded. The gases coming out of the wall has no water vapour in it (air normally does), so using it will give you a dry mouth and you will get thirsty very quickly.

The main concern with entonox has been the recent suggestion that it can upset the bone marrow's ability to make DNA (and therefore cells) if breathed for long periods of time due to suppression of the enzyme methionine synthetase. Evidence seems to suggest that this doesn't become significant for mother or baby until entonox has been used continuously for over 24 hours. To be on the safe side, some maternity units try to restrict its use to less than this time.

Injections:
Pethidine:
Since the 1950s, midwives have had the ability to administer Pethidine to labouring mothers. This tradition is perhaps in need of some review, as more appropriate opiate based painkillers have been discovered and experimented with. Midwives understandably are reluctant to give up any potential means to help their patients, so Pethidine is often the drug recommended first. It is a strong opiate drug, similar to morphine. It is often found to be excellent at relieving the pain of contractions, and is given as an intra-muscular injection (shoulder, thigh, or buttock).

The half-life of Pethidine is about 3-7hours, and this is about as long as you can hope for it to last. There are some downsides of course, which make it less than ideal. Pethidine can make you feel drowsy, nauseated, vomit, and in some cases hallucinations have been reported. It may reduce the frequency and/or strength of contractions whilst it is working. Pethidine crosses the placenta, and is less able to get back into the maternal circulation. This means that your baby gets a stronger dose than you doYour baby gets a stronger dose than you do. This can make baby quite 'sleepy', and may affect the baby's heart rate trace. The real rub is that one of the metabolites of Pethidine (a substance made when Pethidine is broken down) called Norpethidine is quite toxic to baby. Norpethidine's half-life is approximately 21 hoursin the mother, and up to three times that in the baby, can cause convulsions/fits if in high enough levels when baby is born. It is important therefore that your midwife accurately predicts that your baby won't be born for at least 4 hours if you have pethidine.

Meptid/Meptazinol:
A recent addition to the midwife arsenal is a drug very similar to Pethidine, it works much the same way, but has less severe side-effects. Unfortunately, in my experience, women report that it provides less effective analgesia too. It is given in the same way as Pethidine, but baby is OK if born within 2-3 hours.

Patient Controlled Analgesia (PCA):
Some maternity units are able to provide a special pump which is attached to an intra-venous drip. This pump has a button which the mother can press to release a small quantity of opiate into the blood stream.

This way, the mother can precisely control the dose on board, balancing need for pain relief with side-effects. The actual drug in the system varies from unit to unit, but there are two main concerns:

If your baby is healthy, the main concern is not to allow high peak levels of a long acting drug to affect the baby - so a potent, short acting drug such as alfentanil is used.
If however, you are one of the very unfortunate who are delivering a stillborn, a PCA with a longer acting drug such as morphine could be used, as there is no concern about intoxicating the baby, and pain relief is more easily acheived.

It is not possible for you to overdose with a PCA device, as they are designed with a lockout period. Commonly, you are able to get a dose at most every five minutes.

Epidural:

This is the only mode of analgesia that potentially offers complete pain relief. It is a small plastic tube that is inserted through a needle into the epidural space (see above) in your back. The needle is then removed, and the tube can be used to inject local anaesthetics to provide the block. It is inserted by an anaesthetist - a specially trained doctor with experience in all types of anaesthetics.

An epidural is inserted very cleanly to minimise the chance of introducing infection. The mother must sit very still, any sudden movements may increase the chance of complications. It is dangerous to insert any needles into the back when the mother has a contraction, as the pressures in the tummy and back increase dramatically. If a contraction does occur, the anaesthetist just needs to be informed, and he/she will stop until it passes. It is still OK to use entonox during these contractions, it helps you to stay still!

There are risks associated with having an epidural, but they are generally very safe. They can drop your blood pressure, which can make you feel dizzy or light-headed. Your baby must be monitored in case the drop reduces the blood supply to the placenta. Before an epidural is sited, an intravenous drip is placed in your hand/arm so that fluids or drugs can be given to stop the drop in blood pressure from becoming a problem.

In approximately 1 in every 100 epidurals in labour, the needle or plastic tube puncture the membrane between the epidural space and the subarachnoid space. The subarachnoid space is filled with nerves floating around in fluid. The hole made by the needle/tube can allow this fluid to leak out, giving the mother a headache. It is important to mention a headache to a healthcare professional should it occur. The Post Dural Puncture Headache (PDPH) is like a migraine, is worse when sitting, standing, or straining on the toilet. It is made better by lying down, and is sometimes associated with neck stiffness or changes in vision. If you do get this complication, one of the most effective treatments is the 'blood patch'. This is another epidural needle inserted into the back, and 20mls of the mother's blood inserted into the space. The blood forms a clot over the hole, stopping the leak while the hole fixes itself over the following six weeks.

Often, an epidural will cause weakness in the legs, so the mother is usually confined to the bed. This is not the case in some units, where a low-dose 'mobile' epidural is used. It is still currently uncertain whether epidurals cause an increased chance of instrumental delivery (Ventouse / Forceps) recent evidence is that there is, but there are so many other factors that it may be impossible to tease out the difference. There isn't an increased chance of having a Cesarean section if you have an epidural.

There are two different dose regimes that could be used. One is to give bolus top-ups of local anaesthetic each time it starts to wear off, and the other is to give a continuous infusion. Both are similar in their effectiveness, the bolus technique has been shown to have a lower total dose overall, and gives a longer time until other forms of analgesia is required post-natally.

Many women are worried about the risk of nerve damage from the insertion of an epidural. Recent audits suggest that the chance of any temporary nerve damage only occurs in 1 per 10,000 epidurals, and permanent nerve damage only occurs in 1 in 20,000 epidurals, so they are considered to be particularly safe.

Summary:
There are many techniques for dealing with the pain of labour and delivery, some are simple, and some are more complicated, but more effective. It is important to make informed decisions about what you want in your labour, and to get advice from your healthcare providers, they can give you more information and discuss what's best for you.

Written by Dr. Michael Greenway, SHO in Anaesthesia

A weighty subject

2006-08-05T11:41:00.000Z

More pictures of the baby Joshua. I realise whole-heartedly that pictures of one's own baby are infinitely more interesting than those of anyone elses, but I can't help but force them on you. Of course, you can always read another blog or news site, but if you happen to have subscribed to the Atom/RSS feed for this site, I'm afraid your blog reader software has already downloaded them - you might as well look at them now.We had the weigh in at 5 days old, but it was bad news. Apparently babies commonly lose up to 10% of the their birthweight by day 5, but Josh had lost 15%. He is still a well looking baby, and we think he is still perfect, but our community midwife tells us to feed him 3 hourly for the next two days until a reweigh on Saturday - any time now in fact.We have thought about excuses as to why the weight is so low, obviously being slow to feed in the first few days is the prime culprit, but next on the list was the malfunctioning scales at the hospital. The digital scales weighed him at 3lbs, so that was obviously wrong. They determined his birthweight by using the old analogue scales in the recovery room - Not sure when they were last calibrated, and they certainly weren't calibrated against the digital ones that were brought to the house. Anyway, excuses aside, we are hoping against all hopes that Josh has become heavier than 2.720kgs, so that the rest of the day isn't spent in hospital.

He’s finally here!

2006-08-04T15:31:00.000Z

My goodness, it’s been a tough few days, and obviously the family comes first so I’vè not been able to tell you all about the new arrival.

Joshua William was born on Saturday 29th July 2006 at 07:08am, weighing in at 3.2kgs (7lbs1oz). It was a gruelling labour, and that was just my impression of it! Rachel started contracting around Tuesday, but irregularly. They started becoming regular (6 mins apart) at dinnertime on Wednesday, and we kept a close eye on timings overnight. I rang in to work in the morning on Thursday, and they very kindly said I could stay at home - the real problem for them was that I was about to embark on a week of night shifts, so they ended up having to get an external agency locum (I’m feeling a bit bad about that, but as I say, family comes first!)

The community midwife came to see us in the afternoon and confirmed we were in labour, with good progression for a first-timer especially two weeks early! We continued to monitor the contractions, but they didn’t really change much until dinnertime, when they upped to 5mins apart. I got very excited, and thought we ought to be contacting the hospital and going in. Rachel on the other hand, suggested home would be more comfortable for the time being, and so we rightly stayed at home. It proved to be the right decision, because they slowed down after tea to 7mins apart. Getting a little fed up and confused with it all, we tried to retire to bed. It was a humid night, and the heat was uncomfortable to say the least, but luckily the air conditioning unit I’d bought the day before cooled things down.

By next morning we’d had enough and rang delivery suite. We went in and were re-assessed. Amazingly (I thought), we’d gone from 1cm dilated to 3-4cms. From the midwifes’ point of view though, this wasn’t good enough and we were turfed out to the ward. After spending much of the day rubbing Rachel’s back, and going for short walks to get things moving, we were examined again, and we were at... 4cms. Although this was disappointing news, they considered it a step in the right direction, and we were admitted to Delivery Suite. Of course I already know the place inside out, and am friends with most of the midwives, so it was a nice place to come for me - obviously Rachel had little experience of the place, and coped very well.

Things went from slow to slower. During the next 6 hours we tried Entonox, different positions, and more back rubbing, but the pain continued to get unbearableDuring the next 6 hours we tried Entonox, different positions, and more back rubbing, but the pain continued to get unbearable. Looking at the clock, considereing that the latent phase of labour had been going for 6 hours, I reckoned one shot of pethidine should tide us over before the second stage and all that pushing. We were reexamined later in the evening, and we were ready to hear that progress had finally been made... 4cms.

Rachel looked ready to cry, but I reassured her that at least now the pethidine would be kicking in and she could get some sleep. Just as she was about to nod off, our midwife looked at the CTG trace, and made a mad dash for the door. Seconds later, the senior midwife came in and they examined the tiny piece of paper intently. Rachel was wide awake again, and the midwives told us that the baby was probably sleepy from the pethidine. They told us not to worry, after the trace became a bit more reactive with some cold water and prodding (Rachel drinking and the bump prodded that is, we weren’t doing that to the trace.) but Rachel wouldn’t settle until the trace improved - not surprisingly, it got better at the same time as the pethidine wearing off.

We had an ARM (artificial rupture of membranes) to get things moving, and settled down to wait for another two hours. Had there been no change by then, there was to be a Sintocinon drip to encourage the contractions to be stronger and more regular. I was aware of course that this was all straightforward and normal, but there was no convincing Rachel that more intervention was a good thing (mind you, I bearly believe that myself). We waited for the all important reexamination, with baited breath. Our midwife asked me where we had been at the previous one. “4 cms” I said. She looked confused and I could see it coming. “I make it 2” she said. The world collapsed. Rachel was inconsolable, and I couldn’t believe it. The drip was to be started. However, I was in a position to know that Sinto = even more painful contractionsSinto = even more painful contractions, so I insisted on an epidural before the drip started. Earlier in the day, my consultant had introduced herself to Rachel and told us that no matter what time we requested an epidural, she would come in and do it, which was immensely generous. She came in at around 23:00, and it worked like a charm. The block was good, and Rachel lost even the sense that the contractions were happening on just 10mls of 0.25% Levobupivacaine. Finally, she could get some rest while the sinto did its thing.

However, our night midwife had a different ethos to the day one, and stayed with us constantly - probably because of all the interventions we’d had, and all the monitoring we had to have now. There was so much fiddling and adjusting and reviewing that there was no chance either of us could rest. Four hours after the sinto was up and three epidural top-ups later, we were due another examination. Our midwife looked at us with the same confused face, and we could feel the bad news on the tip of her tongue. “Guess” she said. ‘Toying with us, how cruel’ I thought. We suggested that at least we might be back to 4cms, but she smiled at us. “9cms, almost fully dilated”. It was like someone had given us a breath of fresh life. OK, well perhaps not fresh, maybe a breath of life that had been hanging around in a gym locker for a day or two, but we felt a hundred times better.

We tried a bit of pushing after a further hour, but the midwife quickly spotted blood being discharged. The Senior Registrar came in and agreed it was unascertainable where the blood was coming from. He decided we needed a Ventouse delivery in theatre, in case there was the need for a Cesearean section. We had an epidural top-up that would give most elephants cardio-accelerator block, and she started to complain of tingling in her fingers and drowsiness - OMG, not this as well I thought, as I raised her head end!

The powers that be must have been smiling on us after all, because to contractions later we had a baby boy on Rachel’s tummy, and we couldn’t believe it. “It’s a boy!” shouted all my day-to-day colleagues - “It’s a baby” I thought bewildered. After a quick clean up, and check over, he was in my arms, and opened his eyes. Absolute perfection in my hands. I never really felt the empathy towards Dads and Mums during that moment of first meeting, but I had tears in my eyes. It was a good while before all the madness calmed down, and the weighing and measuring, monitoring, etc. was gone. We’vè had no end of visitors and presents and photos since, which has been wonderful. I’ll keep you all posted.

Monty Python - Galaxy Song

2006-08-01T11:45:00.000Z


Hadn't seen this before, it's great!

My best man’s wedding!

2006-06-30T12:10:00.000Z

My best man's wedding. It's been a long time coming! Having known each other for almost as long as Rachel and me, Leonard and Libby finally tied the knot two weeks ago. It was a glorious day. Rachel and I travelled down to Somerset the day before and checked into the inn down the road. It was very nice at the Hood Arms, the staff were friendly and they had a lovely old dog who roamed around the bar. We got up early the next day, and having some hours to kill had a trip down to Kilve beach.

Apparently it's a Site of Specific Scientific Interest, something to do with lots of fossils. We had a lovely walk along the coastal path, and met lots of the local wildlife - butterflies, rabbits, foxes (not trying to eat the rabbits amazingly). We managed to catch site of the house where the wedding was to take place, which looked amazing. The manor house (St. Audries Park) was as impressive close to as it was from afar. Great towers loomed, the walls draped with ivy, and the inside decorated with more oak than in the wood outside! The ceremony was lovely, they married in the Orangery and we had Champagne in the sunshine afterwards.

There was a croquet lawn, which brought the male competetive instincts (including my own). Dinner was delicious, a string quartet played throughout. Trying to film the speeches was a little tricky as we were right at the back, but we still heard Len's Best Man's slip up!

Anyway, the weekend was finished off nicely by visiting our Goddaughter Nicole, and the rest of the family. They really are growing fast! Won't be long until we've got a small person of our own to care for, he/she is due in just over six weeks!

Career problems

2006-06-30T11:54:00.000Z

When I first started anaesthetics, I was pleased with the idea that I could be an SHO (senior house officer) for a couple of years, then be eligible for the idolised position of the SpR (Specialist registrar), a position that comes with reverance and respect from HOs and SHOs alike. A comfortably secure five year training programme as an SpR, rotating round various hospitals in the region gaining experience would be ideal in my current situation - a new father needs some job security and to know what is coming for the next few years. However, this goal is now looking unobtainable.

This government has brought in so many reforms, and altered the workforce so dramatically, by increasing graduate numbers, by shunning non-EU doctors, and changing the training infrastructure that things no longer are even close to certain. The introduction of MMC (modernising medical careers) and RTT (run through-training) has been rushedThe introduction of MMC (modernising medical careers) and RTT (run through-training) has been rushed. It was designed to push junior doctors through their training faster to increase the number of consultants to the government's target level ASAP. Unfortunately, this desire to acheive targets has meant that junior doctors are unclear on the process they are about to embark on. Myself, I have been told I will be eligible for an ST3 post (the specialist training will be from years ST1 to ST7 or ST5 depending on who you listen to) but how I am to apply for this is uncertain.

My college tutor seems just as in the dark about what I am to do, and cannot help. The bit that really gets me, is that in order to make space for ST3 anaesthetists, the last permanent appointments to the hallowed SpR rotations will be December 2006. I would have been eligible for my SpR job from March 2007, so close!!! No-one at my institution, nor anyone I have spoken to knows what will happen at the end of the first ST3 year, and especially what will happen to all those who successfully complete their 'ST' years. Will they all get consultant jobs? Will they be channelled into cub-consultant grades? What about those who struggle to get passed the competitive entry to 'ST'? The younger ones can have up to two years trying to get into this training scheme, but after that what happens to them? Do they have to retrain as something else? GP? Medicine? Surgery? Will they have to emigrate to the USA/Australia? I feel that there needs to be full transparency in this process, and that the juniors need more information to be comfortable with all these changes to their training.

I'd really like for there to be an information leaflet to be waiting for me on my doorstep from the Royal College when I get home.

The exam’s over!

2006-06-30T11:24:00.000Z

So! It turns out that life can be pretty demanding on one's time, and I don't have hours on end to play 'top blogger'! I think I last wrote about cramming madly for the Primary FRCA exam, back in April. Good grief, what a roller coaster ride. The exam revision was gruelling on all involved, myself, Rachel, my close family, my friends (OK, so I'm not sure if they didn't secretly enjoy being left alone ;-) ), but all together I hardly saw anyone other than at work, or during weekend viva practice sessions with my buddy Lloyd - yes, not the rabbit.

The longer it has been since the OSCE and viva day the easier I remember it being. No doubt if I'd failed, I'd remember the true horror. My first part to the exam (in London) started at 8.20am, so I had to travel down the day before. I decided it best to travel by train, as anyone knows, parking in central London is a big no-no! Trying to travel light however, I travelled in my super shiny new shoes. Therein lay my first mistake. I arrived in good time at St. Pancras station, and began the hike to my hotel. The first 250yds were OK, but soon after that I realised the sound coming from my feet must be leather on bone, because it certainly didn't feel like I had any heels left! I persevered, and arrived at the Holiday Inn Bloomsbury and was surprised by its smart interior. I hobbled over to the reception and told the lady my name. 'Hmmmm.... Ummmm... Are you sure you have a reservation?' OK, problem number 2. I had somehow managed to book a different Holiday Inn, on the internet, despite having clicked the 'Location/Map' link and making sure I had the right one. 'Oh, no sir, you have booked the Holiday Inn Bloomsbury Kings Cross. My heart sank, I'd just walked from there! She gave me a map and marked the spot where my new destination lay. After checking my pedal pulses and estimating blood loss as acceptable, I decided it prudent to get the Tube back to King's Cross station and walk from there. After more painstaking tiptoeing, and the sun beating down on me like a stranded desert man, I turned the corner before the X on the map. Where's the Holiday Inn? Ummmm... Oh dear, the clever woman has mismarked the map. From my vantage point I can see a Travelodge, and go in for help. 'Yes sir, your hotel is a good 3/4 mile down the road from here'. So I set off again, about to expire from dehydration and anaemia. Finally, the hotel looms down on me, and I check in without the energy to kick off.

Exam day went much more smoothly. My morning breakfast at the hotel was left half eaten, my nerves quivering. I arrived at the Royal College of Anaesthetists and went in. As is customary at medical exams, everyone is dressed well in suits (quite out of character for gasmen) reading textbooks, trying in vain to grasp that last insight into the innards of a laser, or how chest compliance is made up. I met a friendly chap by the name of Steve, who became my bosom buddy for the duration. Lloyd had already been through his OSCE/Vivas on the Monday, passing well, and being Friday he'd had chance to tell me the gruesome reality. He'd had Dr. Colin Pinnock for his Physiology viva - I'd chuckled, he was the main editor for our revision textbook "Fundamentals of Anaesthesia". It served me right, I walked into my Clinical/Physics viva, and the man there said "Good morning, I'm Dr. Pinnock. This other chap is Dr. Nicholas Hirsch." My heart sank, but at least the second viva was going to be from an unknown! It wasn't until after lunch when I spotted another well known textbook that Dr. Hirsch is the second named editor of 'A-Z'. Phew, I thanked whoever is in charge that I never knew!

The OSCE didn't start well either. My first station was an anatomy station, 'Tell me about the anatomy of this plastic sacrum'. Oh dear, I'd given it a cursory glance, but only knew about the bone, not any of the clinical detail surrounding it! It got better however, and as my confidence grew, the stations began to feel more normal, more comfortable. There was enough time to fit in a couple of pints before the results were out. I spotted my candidate number quickly on the pass list, and went over to the 'Winners' circle'. I call it that because those had passed were invited to have a glass of wine and a pat on the back with the examiners. It felt awkward to leave the sobbing failed, and be singled out for congratulations with the others. Luckily Steve, myself and the others from the pub had all passed. Thankfully, the alcohol numbed the still aching pains from my feet and I stumbled home via the station. I'm now in the process of tutoring the next batch of hopefuls from my hospital before the millions of minute details fall out of my head. Good luck everyone!

Hypno-Surgery, Live!

2006-04-11T09:58:00.000Z

There was a fantastic live TV show last night on More4. "Hypno-surgery live" was an attempt to show that the power of the mind is good enough to enter a state of hypnotic anaesthesia for a Umbilical herniorraphy. The patient went through 6 weeks of mental preparation, and last night was the test. He did remakably well, and managed to get through it without any problems. I was amazed when he sat up afterwards and stepped down from the operating table.

Blimey! I've just read a blog entry by a hypnotist about how to provide oneself with anaesthesia using mind power alone. This could be a particularly interesting development. There has been a place for hypnosis in surgery for years, but with this new media interest, I could do with getting myself on a course fast!

Woodland wonderlands, sub-tropical paradises and Aston University

2006-04-10T14:39:00.000Z

I've just discovered someone else trying to spread the word about the plight of becoming a Junior Anaesthetist, but from a slightly more practical angle. Cobus Steyn is a South African junior, trying to give us some handy hints in the real world Operating Theatre, good luck Cobus! http://anaesthesiacorner.blogspot.com

Anyway, the MCQs are over! It’s been a while since I could continue the next chapter of this blog, for the beast of the FRCA primary was roaring louder and louder, and it was getting a little difficult to concentrate on anything else. If nothing else, the ‘quiz’ was a great day out. After being sat in the lounge or the conservatory day in day out for several weeks, a trip to Birmingham in the sunshine was lovely. I spent the morning drowning my nerves in coffee and tea at the Starbucks in the Bull Ring shopping centre, they have a great view from their squishy chairs across the market (a place where I once had one too many cockles and spent the following 48 hours with my head down the loo!) and people came and went around me, taking a curious glance at the reams of text in front of me. Last minute revision done, I took a walk to the university. It was great to meet up with old friends - there were several buddies of mine from Burton who had since moved on to other hospitals all nervously awaiting their destiny.

The exam itself was ‘harsh but fair’ with many questions seemingly making no sense whatsoever, but all becoming vaguely familiar if dwelled upon. The results come out this Thursday, so the entire family have their fingers, toes and all other extremities crossed (mostly paws) for the outcome.

Two weeks before, Rachel and I went on a break to leave all the stress behind a chill out for a week. As usual, it was mostly planned moments before departure (we never give friends more than 48 hours notice!), and we set off to South Wales to see some good friends of ours. The journey down there was OK, we ran a little late, but dinner was almost ready for us when we arrive“Is that a normal noise for round here?”d. After a few glasses of vino, and a delicious meal we retired to the lounge for a chat. We’d hardly been relaxing for 30 minutes, when a particularly loud crash penetrated the stills of the Welsh valleys. My senses a little deadened, I remember thinking “Is that a normal noise for round here?”. I realised it quite obviously wasn’t when Holly (our hostess) leapt to her feet. She ran to the door, and almost collapsed in surprise. We rose to our feet and observed the devastation outside. It was like a scene from Casualty, a Ford transit van with “Celtic Tyres” emblazoned on the side had collided with Holly’s car, parked on the street outside.

After assessing the driver, and removing his concious and mobile (but confused) body from the possible fuel leak from Holly’s car, he collapsed and needed my assistance again. The others went to look for other casualties, and assess the damage. They came back with bad news. Not only had there been enough force to cripple Holly’s car, but it was also sufficient to lauch the wreck into the next car in the street, and the next one after that!

That’s when the realisation came, the second car belonged to Holly’s partner, Chris. His Citroen Saxo was in just as bad a state as the first car, the front bumper was in the garden somewhere, and there were bits of engine all over the road. The third car, of course, was mine. Luckily the back end was folded in and not much other damage had been caused. Unfortunately, my car has central locking which refuses to lock if a door is open - the boot being wedged open meant that I couldn’t secure the vehicle and had to move everything indoors.

What with the car potentially undriveable, the rest of the holiday could have been in jeopardy. A call to the insurance company in the morning and a very very nice man from the RAC (oops, that’s the AA isn’t it?) and we were restored to Burton on Trent. Luckily, the “I think action-packed could be a bit strong”garage had a courtesy car available, and we headed straight back down south to Longleat, Wiltshire where we had reservations at Center Parcs. We had a great time, forgot all about the car, and had an action-packed week in the woodlands. I think action-packed could be a bit strong, Rachel drew up a schedule for the two of us - I got up at the crack of dawn and revised, while she slept in until noon. Then we’d go and doing something mildly strenuous, like swim in the outdoor heated pool or visit the Safari Park next door. We’ve always loved the Park, and the house for which Longleat is famous. It’s been lovely to keep in touch with the place since we left Bristol on the BBC’s Animal Park.

Just before we headed home, we were able to call in on the friends who we missed thanks to the incident. They have a beautiful son, who is growing up to be the most gorgeous young lad. If we manage to do as well as they have, we will have no problems with baby Bruce. Our 20 week scan was fine, there were no problems, after dealing with Bruce’s camera shy attitude (he started with his back to us!). Still, it’s certainly a weight off our minds that we are hopefully expecting a healthy baby.

What is still a considerable weight is the thought of the next chapter of the FRCA - the OSCE/Viva in May. If I’ve passed the MCQs, this is what I’ve got to look forward to next.

Trip to the Lakes

2006-03-03T17:43:00.000Z

End of a week of nights... Ahhhh. ITU nights just aren't the same as being 1st-On since CEPOD came into effect, the Critical care patients just don't get better, and you can't go to bed!

Ah well, at least it's over. To celebrate (and to put off revision a bit more), Rachel and I went to the Lake District this last weekend. Oooo, it was lovely. My grandma owns a little flat near Ambleside on the banks of Lake Windermere, and it's a great place to use as a base for the whole area. Of course whilst counting the remaining minutes of the last shift on Thursday morning, there was a flurry of snow and I wasn't sure we'd be able to go! Luckily it didn't stick in the Midlands, but there were plenty of snow-capped fells when we arrived.

What with the baby on the way, there was never going to be a marathon walk on the cards, so we prepared ourselves for a weekend of shopping and eating! On Friday we drove up the Struggle, up to the top of Kirkstone Pass where there is a lovely pub (in the photo above). We were surprised to see kids throwing snowballs and sledging - we had certainly forgotten ours, so we joined in by making a snowman.

The next day was brilliantly sunny, and we thought it best to stretch our legs. There is a perfect walk near Hawkshead that is good for anyone who can't walk too far, round a tarn called Tarn Hows. I have been round there almost everytime I've been to the Lakes as a child, usually the day after a storming killer of a hike that my Dad wanted to do! The tarn was a beautiful blue colour, and the sun was low enough for me to practice some more amateur photography.

After another few gut-busting meals and another walk up to Jenkyn's crag, it was unfortunately time to come home. I guess we'll just have to come up with another excuse to avoid the revision!

Epic Journey

2006-02-12T16:43:00.000Z

Mammoth bike ride yesterday, or so I thought... I grew up in the Burton-on-Trent area, and used to go on bike rides with my friends. We used to travel for miles and miles, and it was usually me who complained about tired legs and a numb bum!

I decided it was a nice enough day for a really long bike ride yesterday and set off. Man! It was freezing, and my hands were like blocks of solid ice by the time I had reached the bottom of the hill near the old Bretby hospital! Anyway, I was really impressed by some of the views:

And I even managed to get an arty snap too:

Imagine my confusion when this biepic, multi-county, almost marathon bike ride was completed, with me having made a cup of tea at home within the hour! It was a most refreshing ride, and I saw places in a new light from when I was a spotty teenager, but being a rather larger chap it didn't seem even a quarter as far.

So, I got home and read some Pharmacology. But lo and behold if Rachel doesn't suggest that I crack on with the DIY in the bathroom. Good plan, except the furniture is from IKEA, and has those lovely pictorial instructions. I found myself peeling glue from the back of the circular mirror wondering 'as if this isn't complicated enough, I have to use some sort of superhuman powers to remove the world's most powerful adhesive - all so the glass was central on the cardboard packaging!'

Anyway, it looks great now, and at least I can look forward to some peace and quiet - oops, silly me, apparently it's the Kitchen next! I think I'll stick with revision, it's no where near as difficult as IKEA and MFI.

Our furry friend

2006-02-07T18:58:00.000Z

I showed this blog in progress to Rachel, and she insisted that I tell you all about the last (but not least) unintroduced member of the family, Lloyd.

Possibly the World's fluffiest rabbit, this Lionhead lop has stolen the hearts of mostly all our family and everyone who has ever met him! This photo was taken years ago when we lived in Bristol, so I've tried to capture him, but he's so nippy this is the best photo I managed to snap!

He's now coming up to 3½ years old, and has already been through teenager temperament stage, and is rapidly becoming as grumpy as an old man. Nevertheless, he has certainly been a good friend to us, and enjoys cuddles (when he's told to!).

So, now you've been introduced to the whole household, apart from Rachel (it's very difficult to get a close up picture of her ;).

Swifter changes...

2006-02-07T12:38:00.000Z

Somebody might have told me that this week was the week of change. I've already told you all about the biggest change in my life so far, and the little tyke that is on the way. I alluded to the fact that I've started exercising the grey cells by revising for the exam, but (I hardly thought it possible) I've just been out for a bike ride.

This is my new bike, Rachel bought it for me for Christmas. It went out when it was sunny last (a few weeks ago I hasten to add), but I actually planned to go out today, and didn't chicken out. OK, so it's not such a big deal for some of you, but I need a really good kick up the ___ before I go and do proper exercise. Well, it was great. Despite the cold, and the traffic on some of the busier roads, and the smell of the B&Q Warehouse fire which could be smelled all over Burton on Trent today, I feel thoroughly invigorated. In fact, enough so to get my Pharmacology book out!

So, that's the plan. It's time to get reading. There are too many distractions nowadays to stop the book work, but with some willpower it should be a successful afternoon. Oh well, back to page 19!

Brain drain and spent voices!

2006-02-05T16:01:00.000Z

So, this is going to be more difficult than I first thought. I've just spent all day finishing off West: "Respiratory Physiology" (7th ed), filled with flow-pressure curves and airway resistances. I'm not sure I'll ever get the hang of deriving the equation for Alveolar Dead Space.

Anyway, I might have spent all today's quota of little grey cells on effort independent flow, but I shall spend the rest of the daylight hours reading to my wife and the bump. We're a few chapters into Harry Potter and the Philosopher's stone - Sorcerer's stone for you 'across the ponders'. She enjoys it because I do all the voices, it's great fun and helps me to relax.

Opening credits... Life gets more complicated

2006-02-04T17:04:00.000Z

Today has been one of the most surprising days of my life. I've seen some things that have made me marvel at the human body, and other things that have amazed me that the body is possible of such amazing disruption.

Nothing I've seen before has prepared me for the shock of seeing my unborn child on Ultrasound today. The moment its face and body appeared on the screen I reached for my wife's hand, spellbound. I've a feeling that this is when I realise that the only time one can stomach the sight of baby photos is when they are of ones' own baby.

However, it has certainly put life into perspective. I realise now that it might be a good idea to pick up a textbook or two, and learn like I've never learned before, because this little person is going to need a supportive family and certainly a Dad with an income.

What with my Anaesthetic Primary FRCA exam looming in April, I could do with getting my career progressed ASAP!

This is my first attempt at blogging, and hopefully there will be more as time goes on and I can try to explain what it's like to be a Junior Doctor in the UK trying to settle down and look after his family.