Medical Humour

The following alternative medical definitions of some common words come courtesy of The Washington Post:

Flabbergasted : appalled over how much weight you have gained.

Abdicate : to give up all hope of ever having a flat stomach.

Esplanade : to attempt an explanation while drunk.

Willy-nilly : impotent.

Coffee : the person upon whom one coughs.

Negligent : describes a condition in which you absent-mindedly answer the door in your nightgown.

Lymph : to walk with a lisp.

Gargoyle : olive-flavoured mouthwash.

Flatulence : emergency vehicle that picks you up after you are run over by a steamroller.

Balderdash : a rapidly receding hairline.

Testicle : a humorous question on an exam.

Rectitude : the formal, dignified bearing adopted by proctologists.

Circumvent : an opening in the front of boxer shorts worn by Jewish men.

Pokemon : a Rastafarian proctologist.

Joking apart… having put up a blog post yesterday (it’s been a while), I’ve been encouraged to update my personal journey as a patient.

I shall endeavour to put up a post by the end of the week… even if I have to stand up to type it. Watch this space!

Let Patients Help

Are you an e-Patient? The most under-utilised resource in all of healthcare, is the patient. Patients need to be allowed to take part in their own healthcare. e-Patients are equipped, engaged empowered and enabled.

Some of you may be familiar with TED.com. TED is a non-profit organisation devoted to “ideas worth spreading”. It started as a conference bringing together people from the worlds of technology, entertainment and design. As well as running conferences, it delivers riveting talks by remarkable people, free to the world. These talks are well worth dipping into for inspiration and thought-provoking perspectives.

Here’s one I really enjoyed… Meet e-Patient Dave.

Thanks to Ann @ Transplant News for alerting me to the above talk.

Tune in next week for an update on e-Patient Steph! 😉

A Breath of Fresh Air

Any patient who has ever worn a conventional oxygen mask for any length of time, will know the discomfort involved and also appreciate the difficulty created by the mask in terms of communication.

An Irish university student, James D’Arcy has come up with an innovative way of delivering oxygen to the hospital patient. The Flo2w offers a new user experience in respiratory therapy and represents a real breakthrough in patient comfort. It’s also more efficient than the current masks used which surely has to be welcomed in this current era of cutbacks in hospital resources?

James has been shortlisted for a prestigious international prize having made it to the finals of the James Dyson Awards. I wish him the very best of luck on October 5th.

“A University of Limerick student has been shortlisted for a prestigious international prize for a revolutionary new oxygen-delivery system.

James D’Arcy is the only Irish entry to make it the finals of the James Dyson Awards with a device called Flo2w.

The device holds an oxygen tube to a patient’s head with an adjustable headpiece that can be clipped on and off.

Mr D’Arcy (23), from Minane Bridge in Cork, has already beaten more than 500 entries from 21 countries across the world to make the final 18. He could win the grand prize of €12,000 plus €12,000 for the design department at the University of Limerick, where he has just completed his final year.

Mr D’Arcy said his invention is a new way of delivering oxygen to a patient and eliminates many problems associated with the current device that supplies oxygen.

“Flo2w eliminates the big, intimidating, one-size-fits-all mask that is currently being used,” he said. “The subtle design makes the user feel as if they are not even wearing it. The oxygen is supplied to the patient through nasal tubing.

“The system integrates a new form of regulating oxygen in an innovative and easy way for both the patient and health care professional.”

Other inventions to make the global shortlist include an ultraviolet sportspack designed by a Canadian that eliminates bacteria and odour from the user’s shoe.

The James Dyson Foundation will announce the global winner on October 5th.”

Information Source: The Irish Times and the James Dyson Award.

MRSA Awareness

Everyone has heard of the hospital superbug MRSA and many have a view on how to stop it. I recently came across the results of a survey carried out in Ireland*, to assess the knowledge and perception of methicillin-resistant Staphylococcus aureus (MRSA) among the general public.

The study concluded…

“The public are generally knowledgeable about MRSA but most agreed that they would feel angry and afraid by its diagnosis. Future public education campaigns on MRSA should be aware of this response.”

MRSA infection can be very serious or even fatal so it’s easy to understand why people would be afraid of a diagnosis. I was pretty scared when first diagnosed with MRSA but I can honestly say that I did not feel angry about it. The only time I felt any anger was when I was exposed to the stigma attached to MRSA, by hospital staff who had not been properly trained in infection control. Why is it then that most people in the above survey, agreed that they would feel angry if diagnosed with MRSA?

I can’t help but feel that the media coverage of MRSA has a lot to do with the opinion of the general public. The newspaper coverage tends to be alarmist in nature and is centered around individual’s stories. MRSA is a problem and should be reported but the media should reflect the whole story about MRSA.

Hospital cleaning is part of the answer but so is the reduction of antibiotic use, which is regarded as one of the most effective ways of reducing MRSA. More microbiologists are needed as well as more infection control nurses. Increasing the number of isolation units so those with MRSA can be treated without the fear of infecting others, is also part of the answer as well as reducing bed occupancy rates in hospitals.

And always remember… the most important thing you can do to reduce the spread of MRSA, is to wash your hands thoroughly and often. If soap or water isn’t available, use alcohol-based hand sanitizers.

How do you think you would feel if you, or someone close to you, was diagnosed with an MRSA infection? Would you feel angry?

* This survey was published in the British Journal of Infection Prevention.

It’s Just Not Fair

It is a disgrace and a source of national shame that in 2010, in the country with the highest rate of cystic fibrosis (CF) in the world, we still do not have a purpose-built adult CF unit. An independent review of CF services in Ireland by Dr R.M. Pollock, published in 2005, found that most adults with CF were being treated in facilities that were dangerously inadequate. In reality, very little has changed since then for CF inpatients. The average life expectancy for a CF person in Ireland is a full 10 years lower than in Britain or the US, largely because of the failure to provide specially trained staff and sterile, en-suite hospital facilities. It’s just not fair that people with CF should be spending so much of their already short lives waiting for the most basic of services.

St Vincent’s Hospital, Dublin is the national adult referral centre for CF patients in Ireland. Last year, the HSE said that it didn’t have the money to go ahead with building a special 120 bed facility, with 30 en-suite rooms to cater for these patients. The public outcry that resulted, led our Minister for Health to declare that an alternative funding approach involving builders and banks, could deliver the facility as promised. This latest hold-up has come about as a result of a failure on the part of the Department to award a tender to construct the €40 million unit.

Orla Tinsley is a young woman with cystic fibrosis. For the past five years, she has campaigned vigorously for the provision of a dedicated CF unit. While receiving urgent medical treatment at St. Vincent’s hospital last week, she wrote the article below about her frustration that the designated site for the new facility remains empty…

“OPINION: The news that there has been further delay in the cystic fibrosis unit at St Vincent’s hospital in Dublin is disheartening, but hardly surprising, writes ORLA TINSLEY

Five years ago this month, my first article was published in this newspaper. I wrote about being an 18-year-old with cystic fibrosis treated in the national referral centre, St Vincent’s hospital. It was my first experience of sleeping in a room with senile and confused women who coughed, pooped and died in the room in which I slept.

I didn’t understand how the rules on cystic fibrosis care could change so much from a children’s hospital to an adult hospital. As a child I was not allowed to share a room with someone who had cystic fibrosis because of cross-infection.

In Vincent’s, sharing a room with another CF patient was a common occurrence until two years ago because there was no other space. I shared a room with a girl who also had CF and we became great friends over the summer months we were in there. We stood outside the hospital on the June bank holiday eating cool-pops and watching the mini- marathon go by. A month and a half later she was dead.

It was the first time I fully realised that CF is something you cannot control, although it takes a while to accept.

I ran the mini-marathon two weeks ago and finished in high spirits. When I sprinted past Vincent’s, I thought briefly of that day and was glad to be running. The next day I flew to Barcelona and lay on the beach, relaxing for five days. I had gotten over the previous rough summer of spontaneous lung bleeds that halted my life and made it impossible to plan anything. I had gotten over the collapsed lung last year and I started work, like any 23-year- old, which feels so great.

Then I got some shoulder pain: my lung had collapsed again. Had I trained too hard or done something wrong? My consultant said it was just one of those things that happens with cystic fibrosis.

Admitted to Vincent’s a week ago, I was put on 100 per cent oxygen to try and reinflate my lung and given painkillers. My medical team were incredible and I got a bed immediately.

For the first two days I shared a room with five other women on a ward where the staff did not specialise in cystic fibrosis. I was exhausted and filled with painkillers; I was not as aware as I needed to be. When I had to go for an X-ray, the nurse looking after me said I didn’t need oxygen to go along with my wheelchair. My oxygen saturations were good and it was a short trip.

I explained she was wrong, the oxygen was flushing the nitrogen oxide out and encouraging the lung to reinflate. We argued but I left without oxygen. I waited there without oxygen among patients who were coughing.

The ward sister apologised that I had been left without oxygen.

The distressing element of this scenario is that if I was in a unit with nurses specially trained in CF, this would not have happened.

I am just one person with cystic fibrosis and each person’s story is so individual. When I am not sick I work as hard as I can and I love my life. I know some day that that will end, things will get slower, I will spend more time lying in beds with various tubes.

I will be unable permanently to make that choice to get up myself and walk away from a screaming room-mate or a dying woman or drag all my medical equipment and tubing with me to sleep in the corridor, as I have done on previous occasions.

Not being able to access a single en-suite room when I needed one was not surprising, but it was frustrating. The lack of sincerity in the Government commitment to our dedicated CF unit is disheartening and degrading to the 1,300 people living with CF on this island.

There has also been no commitment to the number of beds that would be specifically ring-fenced for people with cystic fibrosis in the 100-bed unit that will treat many other illnesses.

We need 34 beds to deal with the daily intake of patients with cystic fibrosis. These beds cannot, as it has been suggested by those in charge, be given to other patients if people with cystic fibrosis are not there to take them.

We need cleanliness and exclusivity. We’re not asking for gold-plated oxygen tanks, we’re just asking those in power to help us stay alive in rooms that comply with international standards.

This litany of broken promises is embarrassing for Ireland. When I talk to patients or parents of young children abroad they are continuously shocked by the standard of care for CF patients here.

They have offered money to sort out our Irish mess.

I do not want to die in our Irish mess.

The eight single en-suite rooms at the national referral centre are not enough. We deserve single en-suite rooms when we present at hospital with a mild exacerbation or a painful, collapsed lung. It is the only way to get full quality treatment for most patients with multi-faceted cystic fibrosis.

People waiting on the transplant list deserve to be in single en-suite cubicles.

This time coming into hospital, I didn’t have to go through AE, but I will have to again. This time, no one used the room I slept in as a toilet or had MRSA or screamed throughout the night, forcing me to sleep in the corridor.

But it will happen again and is happening to other people with cystic fibrosis around Ireland who are exposed to life-threatening cross-infection as you read this.

The Pollack report was published in 2005. It  In reality, very little has changed since then for CF inpatients. When building eventually starts on the unit, it will take 14 months to complete.

We live in hope with a heavy dollop of cynicism, as always.

I walked by the site in the sunshine the other day during physiotherapy. It sits there, decanted and waiting, just like the rest of us.

If there’s such a thing as campaigners fatigue, I may be experiencing it. I have been writing the same thing for five years. It’s a depressing thought that I will be doing it for another five”.

I salute Orla Tinsley for writing this courageous article. It’s a damning indictment of our government’s appalling lack of commitment to CF patients who continue to be exposed to life-threatening cross-infection. The Irish political system is rotten to the core if it can allow this issue to continue. It’s just not fair!

Information Source: The Irish Times 25/06/10 and 26/o6/10 and The Cystic Fibrosis Association of Ireland.

Stranded

Dying to get home. It’s no fun getting stranded especially when you’re on your own. Just imagine it…

You’ve spent an exhausting day anxiously waiting for news. It seems no-one can tell you how long the wait will be. You try to pass the time by reading but the constant level of activity around you, makes it impossible to concentrate. Each time you visit the toilet, you risk losing the cramped space you’ve made your own.

Night time comes but there’s no prospect of getting any rest. Sleep is impossible in the noisy, brightly lit environment. You lie there exhausted hoping that tomorrow will be a better day.

Yes, I did feel sorry for all those people stranded in airports last week but not half as sorry as I feel for the many patients stranded every day in our overcrowded emergency departments while awaiting a hospital bed.

Four years have passed since our Health Minister, Mary Harney declared A&E overcrowding a national emergency yet still the number of patients on hospital trolleys continues to reach record highs.

I Know Him So Well

I traipsed into the hospital again this week as the recurring symptoms in my head had begun to wear me down. I was in need of reassurance and I knew that the surgeon would put me straight. After years of dealing with the infections in my head, we’ve got to know and respect each other well.

On entering the examination room, the surgeon asked if I would mind having two young medical students present while he examined my head. I was perfectly happy to agree to this, in fact I positively welcomed it. I knew from previous experience that it was likely to add an interesting dimension to the consultation.

While the surgeon was preparing the endoscope, I chatted to the two female students to put them at ease. I asked them what they thought of the new HPAT (Health Professionals Admission Test)* which was introduced last year as part of the entry exam for medicine. They reckoned the test had evened out the ratio of male/female students that succeeded in getting into medical school last year. In recent years, the percentage of students studying medicine has been 70/30 in favour of females. This would suggest that an aptitude test suits the male psyche better, while swotting for exams is more of a female forte. The surgeon then piped up and declared that if he or any of his colleagues were asked to sit the HPAT today, he reckoned they’d all fail. We all laughed at this concept.

The room went silent while the surgeon delved deep inside my head with the endoscope. Shortly afterwards, he emerged with a large lump of something horrible and announced triumphantly “that’s some bogey”. I’m beyond mortification at this stage so I just grinned over at the two girls who looked horrified on my behalf. The students looked on in silence as the surgeon and I continued to banter about the state of my head. The many years of treatment have left us both comfortable enough in each other’s presence, to be able to employ banter as a coping mechanism. The girls were not aware of my previous medical/surgical history and therefore had no idea that I knew this surgeon so well. The look of disbelief on their faces, was priceless.

When the surgeon had finished his task, he took photographs of the inside of my head and used these to reassure me about the cause of my present symptoms. It appears that the donor site used for the recent graft surgery, is slow to heal and is causing irritation to surrounding structures. My post-operative check-up in Nottingham next week, should elicit more information on this. The good news is that the graft continues to heal well.

Before I exited the room, the surgeon gave me a big grin as he explained to the students that I was no ordinary patient. “This is a very rare case”, they were told.  I grinned back and left him to explain.

*The HPAT allows all Leaving Cert students with over 480 points to apply for medicine. Entry is decided by a combination of CAO points and HPAT results, which examines spacial and logical reasoning, problem-solving and interpersonal skills.

With thanks to the Amateur Transplants for the parody.

In case you didn’t know… the ABC used in the above video, is a well-known mnemonic for AIRWAY, BREATHING and CIRCULATION. The ABC protocol exists to remind rescuers delivering emergency treatment to an unconscious or unresponsive patient, of the importance of airway, breathing, and circulation to the maintenance of a patient’s life.

Patients know best

Had you been wondering where I’d disappeared to? Sorry about that. My elderly parents are in need of an extra helping hand right now so I’ve been otherwise occupied. I’ve also had the little business of an operation to recover from and that’s kept me somewhat quieter than usual. This week, it’s definitely been a case of Steph nose best 😉

Recovery from surgery can usually be measured in steps. You know the way it is… two steps forward, one back until you’re over the worst and then it’s generally steady progress from then on. My recovery on this occasion has taken on a different pattern. The first 10 days post-op were the easy bit and it’s been a bit up and down since then. If there’s one thing I’ve learnt over the years as a patient, it’s never to doubt myself when it comes to reporting symptoms.

I requested another appointment at the hospital yesterday as I sensed something wasn’t right. The consultant examined my head endoscopically and was able to confirm my suspicions. Despite daily wash-outs since the surgery, the inside of my head had crusted up again and was in need of further Spring cleaning. I continued to insist that I could also smell decay. After working on my head for some time, the culprit was soon identified. The donor site for the graft was to blame. Some dead cartilage was visible on one side of the nasal septum where tissue had been removed and rotated upwards into my forehead, for grafting. Once this decaying cartilage had been cut away yesterday, my airway felt very much better. I was patted on the back for my skills of detection and sent on my way with a request to return if symptoms recur.

The culture of healthcare is thankfully changing from one of paternalistic medicine to one of participatory medicine. Everyone is better off when patients are encouraged to engage with the medical profession.

Patients Know Best is actually the name of a company whose website is already integrated into the NHS secure network and helps UK patients with chronic diseases, to manage their health care.

A-Z of being a patient

My good friend, Grannymar has been practising her ABC’s on her blog and set her readers a challenge. She said, “Pick not one word for each letter, but three that sit well together”.

I’ve had fun mulling over this task all day. In keeping with the theme of this blog, ‘a patient’s perspective on life‘, I decided to base the alphabet on my summer spent in hospital. Here’s what I came up with…

A-Z of being a patient

A’s for A&E, antibiotics and analgesia.

B is the bacteria, blood pressure and breathing.

C’s for cellulitis, colitis and complications.

D is the diagnosis, doctor and dietician.

E’s for ENT, ECG and ESR.

F is the flare-up, fluids and fasting.

G’s for gargle, gastric and gut.

H is the hospital, hygiene and hypertension.

I’s for investigations, IV’s and injections.

J is the junior doctors, joints (sore) and jelly (and ice-cream).

K’s for kidneys, ketosis and being kind.

L is the light-headed, laughter and longing.

M’s for microbiology, medication and meals.

N is the nurse, needles and nausea.

O’s for osteomyelitis, oxygen and operation (and ouch!).

P is the pulse, PICC line and pain.

Q’s for questions, queasy and quiet.

R is the respiration, rest and results.

S’s for scans (CT), syringes and samples.

T is the temperature, tachycardia and tired.

U’s for ulcer, uncomfortable and unwell.

V is the veins, vision and vital (signs).

W’s for ward, wheelchair and WC.

X is the x-ray, Xysal (antihistamine) and Xanax (for anxiety).

Y’s for yawning, feeling yucky and YES ( in response to) “ready for home”?

Z is the Zoton (antacid), Zestril (ACE inhibitor) and Zimmer frame (not needed yet).

Please Missus, I did my best. Do I pass the test?

Preparation for Surgery

Here’s another excerpt from my little book of Home Nursing.  It details the preparation of the patient for surgery…

“On the day before the operation the nurse should ask the surgeon how he wishes the patient to be prepared. If no specific instructions are given the patient should if possible be kept quiet the previous day: he should take only light food, have a warm bath and an aperient in the evening. On the day of the operation he may, if the operation is not to be performed too early, and with the surgeon’s permission, have a light breakfast of tea, with toast and butter, and, three hours before the operation, a cup of tea or bovril.

His preparation begins with a simple enema first thing in the morning. Then he may have a warm bath or be well sponged down.  The area of the operation must now be sterilized by shaving and then cleansing thoroughly with either soap or spirit soap, which must be washed off with hot water; the skin must again be washed with hot biniodide of mercury solution, and covered with a compress of lint or gauze wrung out of the same solution: or, after drying, the skin may be painted over with mild tincture of iodine, allowed to dry and covered with a dry sterile towel.

Before the operation artificial teeth, hair-pins, jewellery, etc., must be removed, and if the hair is long in a woman it should be plaited in two plaits tied at the ends. The patient must put on warm flannel clothes which can be removed easily, and long woollen stockings.”

Now that’s what you call pre-operative care. These days, patients are admitted to hospital on the day of surgery and the pre-op preparation is left almost entirely to the patient. I can remember once getting it completely wrong and I paid the price.

I had a young baby at the time and instead of resting the day before my surgery, I rushed around putting preparations in place for during my absence. The following moring I insisted on getting myself to the hospital so that my husband could stay at home to look after our baby. Having fasted from the night before, I travelled by train to the hospital and arrived feeling totally parched and exhausted. I had a particularly difficult post-operative recovery from the anaesthetic on that occasion and it taught me a lesson. In today’s world of conveyor belt medicine, it’s really important to rest the day before surgery so as to optimise your powers of recovery. Allow yourself to be pampered!

UPDATE: I’ve just spotted this letter to the Irish Times from a Consultant in Emergency Medicine, which fits in nicely with the ‘ patient care’ theme of this post.

“And the Minister should focus on the universal need for a familiar smiling face. Let us have carers who have the time to care and the moral support of a loved one in our hour of need. Health economists may have factored these basics out in their many dubious prescriptions, but Mother Nature has not”.