conversation

"So you're telling me that my baby is going to die? No matter what I do?"
"It has Edwards Syndrome. There is no cure."
"There must be something I can do."
"I'm sorry."
"What did I do wrong?"
"Nothing."
"I look and feel the same but now my baby must die. How can that be possible?"
"I don't know."

"I don't know."

When I was younger I had a technique for delivering bad news. It left me feeling pretty much unscathed.

Now I definitely feel.

information, age

How do you respond when you don't know as much as you would like. It can be embarrassing when a young doctor is better informed on an issue. Or a patient.  It can be hard to admit that you don't know everything in your own field.Some doctors try to bluff their way through,but it is painfully obvious - they lose more respect for that than by their lack of knowledge.


 I try to remember how my mentors dealt with it. Sometimes I was the one with the new information. How did they handle it? As I recall, they encouraged me to explain as much as I could. I was very proud of myself but didn't feel superior. I was just delivering the news.


So why do I feel so embarrassed now? I understand it is the way of the world. But I do not understand the giant babies.


(with apologies to A Softer World)

film review

I saw The Avengers with my son. My review: That Scarlett Johanssen sure wears tight trousers. I forget the rest.

ancient ruins

frozen fresh meat

a typical Irish Pub

I learned to like Guinness at Conways, across the road from the Rotunda Hospital in Dublin. This beer wasn't too bad, even though it wasn't in Ireland.

winter morning

 car roof

 closer view

inside view of windscreen

thirty nine years....old

39 y.o. factory worker, beauty therapist and heavy machinery driver. Now she is developing increasingly heavy, painful, irregular and prolonged periods. She is pleasant and attractive, and would like to have children but has no partner.

She may be running out of time.

ruptured membranes

At thirteen weeks. Definitely proven by ultrasound and the constant stream of fluid. Impossible for the pregnancy to continue, and yet she had already reached twenty four weeks when she came to see me. She didn't want to terminate the pregnancy so she started antibiotics and was arranged to have further tests. She didn't return.
This morning a registrar rang me from another hospital to say she had come there in labour at thirty two weeks and the baby had survived after a period of intubation.
 It certainly wouldn't have lived if she had taken the advice of experts like me.

good name for a boy

I told a mother she is having a boy. She turned to her two and a half year old daughter and said, "What's a good name for a boy?"

Without hesitation the little girl said "Flower Rose".

"brittle"

Glucose control has been very difficult with a pregnant diabetic. When she first came to me she was already attending another hospital for her diabetes so they had continued her medical management while I supervised the obstetric side. Her glucose levels have been high but enormously variable so raising her insulin dose has resulted in severe hypoglycaemic episodes. It has been difficult to watch, powerless to intervene, while her baby is put at risk by the frequent and unpredictable high glucose levels. She has been regarded as one of those "brittle" diabetics that are impossible to control.

Eventually, I could take no more and admitted her to our ward. In the last twenty four hours she has eaten the same meals she claims to eat at home while taking the same doses of basal/bolus insulin. Her glucose levels have been uniformly low, bordering on hypoglycaemic.

She has been deceiving us all this time, even putting her baby at risk.

It is true that there are some people in life that we should simply avoid. However, it is difficult to avoid your own mother while you are still in the womb.

a sunny moment at work

Stickler Syndrome

A connective tissue disorder associated with Pierre Robin sequence, cataracts, glaucoma and arthritis. My patient had surgery for cleft palate, has glaucoma and will soon have surgery for her right eye cataract. You can see that she has a very small nasal bridge.
A primary school teacher, she made the initial diagnosis herself.

                                            She has an incidental gynaecological problem.

weather report

On the radio: "Showers may develop into rain during the afternoon."

                                                                                                                        Well it certainly is wet.

12th century science

Still slowly working my way through England Under The Norman and Angevin Kings by Robert Bartlett. Not exhilarating reading; rather, well researched and thorough. Up to page 522, Chapter 10, Cultural Patterns,Part 2, Education and High Learning, subsection Physical Science: regarding Adelard of Bath who travelled to the Mediterranean in the early 12th century "seeking scientific texts and instruction". He made translations of Arabic scientific works and wrote several books including Quaestiones Naturales (Natural Questions). He explores:

"a host of scientific issues:
 'the cause of the ebb and flow of the tides';
 'why the fingers are of unequal length';
 'whether the stars are animate';
 'why the living are afraid of the bodies of the dead' "

These issues may seem laughable by modern standards yet we now spend an inordinate amount of time studying the "stars" in popular magazines, and, judging by the volume of writing on diet and obesity, the living now seem to be afraid of their own bodies.