Layla's space

With all its sham, drudgery and broken dreams it is still a beautiful world.

Wednesday, May 27, 2009

'Clapton is God'

I went to the Albert Hall recently to see Eric Clapton. When I told people at work that I went, they were like, 'Oh, that sounds cool. Did you enjoy it?' To put it in context - the guy is my idol, he is a legend, I have been listening to his music since I was about 14 and I just could not believe I was there actually watching him play. Yes, you could say I enjoyed it.

Our seats were amazing - I could have walked over and touched him in about 10 seconds (I didn't try). I've never seen a live performance so close (apart from dodgy local bands in my home town). For the 1st couple of tunes I was a bit overwhelmed I think - I literally just sat there with my mouth open and tears in my eyes, and all those years of listening to his stuff over and over again on my Walkman on the way to school, in my room, in the car, etc were running through my head and it was like oh my God Eric fucking Clapton is standing right in front of me playing a Fender Strat! Don't wake me up from this dream!

Thankfully I did calm down a bit after the 1st couple of songs. As predicted, he made that guitar sing. The band were amazing as well - Andy Fairweather-Low had a couple of great guitar solos himself, Chris Stainton and Tim Carmon were phenomenal on keyboards (a couple of great solos there too), as was Willie Weeks on bass, Steve Gadd on drums and the backing vocalists (Michelle John and Sharon White) were pretty powerful. One of his old band members (Doyle Bramhall II - great name) was playing in the support act (Arc Angels) and he joined them for Layla, Cocaine and Crossroads at the end of the set.

I actually looked up the set list from reviews of previous nights and was a bit disappointed that he made 'Layla' part of his acoustic set, but hey, it sounds lovely on the acoustic guitar anyway. But on the night we went he played the full on, storming electric guitar version - I couldn't fucking believe it (cue me welling up like a big girl again). They seemed to have fattened up the sound of the long, meandering piano/guitar bit at the end of the song, which I enjoyed (I always used to fast-forward that bit - a bit long), and then they segued straight into a stonking rendition of JJ Cale's Cocaine - cue all the middle-aged people jumping out of their seats and having a bit of a boogie :)

He did a couple of Cream numbers - 'Badge', which he'd jazzed up a bit so it had a massive sound - loved it, and Crossroads, which was the encore song. I would have loved to hear 'White Room' or 'Sunshine of Your Love' as well, but the guy has a massive back catalogue I suppose, can't please everyone completely.

All in all, Eric rocked his 'front room', as he likes to think of the Albert Hall. I was a bit worried when I read a couple of reviews before the show - they didn't pan it or anything but they did say it was a bit pedestrian and that he looked 'too comfortable'. One of them criticised him for being too casual and turning up in his 'gardening trousers'! Well they can shut it, quite frankly, because he was sublime. I don't know what they expect from a 64-year-old guitarist - acrobatics? Playing the solos with his teeth? He's never been amazingly energetic on stage - he lets his guitar playing speak for itself. And I didn't go there to check out his designer gear - who gives a toss what he wears? Jeans and a shirt are fine with me - and he did look very comfy in his loafers :)

Tuesday, May 12, 2009


At the risk of sounding like some crusty old fart saying 'in my day...', WTF is happening to house officers and SHOs these days?

There seem to be a lot more incompetent/lazy/unprofessional/downright SHIT ones working at the moment. Is it MTAS? Is it the EWTD? Is it just a general change of attitude and loss of professionalism on the part of doctors in general?

In Oncology, for example, the ward SHOs should generally be expected to have done a reasonable amount of general medicine so that they can deal with medical problems which (frequently) affect Oncology patients. I am not on the ward very often - I spend most of my time in Outpatient clinics, often in other hospitals. I need competent SHOs to deal with the ward patients most of the time, with telephone advice from me whenever it is needed. I expect them to know all the patients, to know what's happening with their schedule of investigations, what their blood tests are doing, what their vital signs are doing, and what the plan is regarding their treatment and eventual discharge. I also expect them to get the important jobs done - and this means that if it comes to 5 o'clock and the important jobs are not done, they fucking well stay until they are done, or they hand over to the SHO on call who should get them done. I did that job less than a year ago - I know these are perfectly reasonable expectations that are relatively simple to fulfil.

One of my SHOs is fantastic. He doesn't know very much about Oncology - that is fine, that's my job. But he is a good general medic and he is safe. He gives a shit too, which is becoming increasingly uncommon. The other one, less so. I came to the ward the other day around 5pm (yes, late, but clinic finished at 5) and asked this SHO to sit down and quickly run through the patients with me before I saw them (I wasn't going to make him stay late and go round them, I just wanted to talk over each one briefly). He just sat there, all attitude, blatantly pissed off that he was having to stay one second beyond 5pm. Told me complete bollocks about the patients, e.g.

Me: 'Was her renal function any better today?'

Him: 'Yeah, fine'

Me: checking result on computer 'Actually, it hasn't been done and she was in renal failure yesterday'

Him: shrugs

I eventually got fed up and told him to go home. I then spent 2 hours seeing everyone and correcting his fuck-ups. For example, a lady with an electrolyte imbalance who was losing calcium, potassium and magnesium by the bucketload and needed constant topping up via a drip. She had a 12-hourly bag of plain saline (no additives) running, was dry as a crisp and also had carpopetal spasm and a positive Chvostek's sign - suggesting a dangerously low calcium level. Her bloods showed very low calcium, potassium and magnesium levels. He hadn't fucking checked them. He hadn't written up any fluids or additives to replace her electrolytes.

Having a very low potassium can kill you. This is something medical students know. Writing up intravenous fluids and replacing electrolytes is something the lowliest, greenest house officer in their first week on the job should know how to do. It isn't fucking rocket science - and that's the point. It's not that he wouldn't have known how to sort out this patient's electrolyte balance. He just didn't care.

When I was an SHO (here we go...yes I know it was only a year ago), I would have been mortified if my registrar had to go round writing up fluids for my patients. I would be almost insulted if they checked the bloods on a ward patient - that was my job.

I had a call from an A+E SHO the other day:

SHO: 'I have a man here in A+E. He was diagnosed with skin cancer in March. He's 63. He came in because he's not very well. He's acidotic and I've given him oxygen and some fluids and I think he should be transferred to the Oncology ward.'

Me: 'What kind of skin cancer does he have?' (Thinking, perhaps metastatic melanoma, post-chemotherapy, neutropenic sepsis perhaps...)

SHO: 'I don't know.'

Me: 'Well, has he had any Oncology treatment? You know, like radiotherapy or chemotherapy?'

SHO: 'I don't know.'

Me: 'OK...what's your working diagnosis? Do you think he's septic? Or could he have had a pulmonary embolism maybe? Has he had a chest x-ray?'

SHO: 'Er...he doesn't look like he's had a PE, but I'm waiting for the bloods to come back. I haven't ordered a chest x-ray. But he has cancer and he's going to breach soon [ie about to hit the 4-hour limit in A+E] so he should really go to the Oncology ward.'

Me: beginning to lose it slightly 'Hang you have this guy, you don't know what's wrong with him, you think it must be related to his cancer or his cancer treatment because you're referring him to me, but you don't know what kind of cancer he has or if he's had any treatment for it, and you want me to sort him out for you?'

SHO: 'Er, yes.'

Me: sounding a wee bit terse now 'Get your registrar to look at him, get a working diagnosis, find out some information about his Oncology history, and call me back.' Click.


I mean, WTF?? You make a referral to someone, you get the relevant information and have it in front of you and get your fucking story straight before you pick up the fucking phone! Our letters are on a computer system - even if the patient was confused and had no relatives with him his clinic letters would all be there at the click of a mouse. And at least have an idea about what might be wrong with the fucking person before you try and send them to me to sort out.

For the record, I spoke to the A+E registrar later. He was apologetic. The patient had pneumonia and was admitted under the respiratory team. His cancer diagnosis? He had had a BCC (very slow-growing, usually innocuous skin cancer) removed from his forehead by a dermatologist in March. Never been seen by an oncologist - did not need to see one.

I know, these could be isolated cases of someone who is just shit and someone who just doesn't care. But I have seen the same kind of stuff again and again. My colleagues tell me similar stories (and much, much worse). The over-riding impression I get is 1) junior docs are less competent these days and 2) they don't give a shit.

Are we losing our professionalism? Have we as a profession decided that we're sick of thinking of medicine as a 'calling', sick of papering over the cracks in the system by staying late without being paid to and by sacrificing our personal lives? Do we just want to do a 9-5 job? Perhaps, and perhaps enough is enough for some of us. But that doesn't explain the shitty attitude of doctors who have barely been qualified for five minutes. Surely they haven't had time to become that jaded. Who knows?

I know the system is far from perfect. I know that to deliver the care that patients expect and deserve in today's NHS, you often have to sacrifice your personal life. You have to stay late, go in early, bust a gut. And actually, why should we? How is the system going to improve if we keep 'covering' for it? Fine, so we fire-fight. We make sure we are safe, that we are not negligent, that patients get treated and of course 'first, do no harm'. But we do not go the extra mile to make things perfect. I can understand that approach.

But I'm sorry, there is no excuse for being fucking shit.