Friday, 17 June 2011

paperwork and a pumpkin

Woke repeatedly with pelvic pain .Tried to ignore but eventually had to get up and go to the bathroom.No surprise considering my patients have been reporting the same pain for the last week or two.I try not to complain of colicky pain since women suffer from similar pains frequently.However it is fairly severe.
There is no option for rest though so I have completed the morning operating list and got half-way through a first antenatal visit clinic before a break due to a failure to attend.Pains are improving but worse when moving around and probably much worse with eating.So - when to eat?Hunger vs Pain? Right now Pain is winning .Not looking forward to the next five days and four nights on call.
My secretary  brought me paperwork and a pumpkin.

Wednesday, 15 June 2011

lunch is an idea

Removed a benign cervical polyp.
Reassured another patient she doesn't have genital warts.
Keeping an eye on labour ward.Two in early labour, and an induction of labour for a VBAC(vaginal birth after caesarian section).
Next: check pathology results and phone patient with wound infection, which is slowly improving.
Antenatal reviews,no time for lunch.
Lunch is not a meal, more a state of mind. If I cannot stop and rest for a few minutes, then food doesn't matter.I would rather not eat anything at all under stress.
Later: barely warm lasagne delicious.Pot of tea.Book.Noise. Huh? Brain boot.Who am I? Phone answer.Must move,lift head. Squash face drool phone press answer am obstetrician.Yes hello.Labour ward.
Listen to lengthy story but already know answer - yes I will come in.Second stage delay,maternal fever,OP position: vacuum cup rotation and delivery.Call paediatrician to baby.Our daughters performing in school soiree as we work.
Can I see another patient,baby's heartbeat slow, mother pushing ,slow progress - my VBAC lady - vacuum delivery.All well but can I see another patient next door?
Slow progress, dropping foetal heart rate, OP position - vacuum rotation and delivery again. Baby slow to recover so call paediatrician from seeing first baby.Chat about daughters while she resuscitates baby.Electric cord from resuscitation cot  hopelessly hooked around wheel making cot unusable. Patient's electrician husband unable to fix ,can't roll it out of way,so bring in other cot also and no one can get past.Baby now fine.Go check another patient in early labour .No problem but I know her.Just getting started but crying ,doesn't feel she can cope,too tired and anxious.Offer confidence,faith,belief then suggest she get in warm bath and see if it helps.Wish her good luck and drive home.
No longer sleepy.

weight

From 1995 to 2005 the percentage of adults who are above normal weight increased from 45 to 54 percent.This morning I am reviewing women with diabetes in pregnancy.The median weight - the weight of the middle patient in the clinic - is 106.9 kg.When I was a medical student learning obstetrics only a little over thirty years ago a patient was considered high risk if she was over 90 kg.
I believe that this worldwide obesity epidemic is the result of a diet too high in refined carbohydrates,possibly influenced by the Pritikin diet which was very low in fat.It entered the global consciousness with the message that fat was bad despite the relative good health of the French and Mediterranean cultures who do not follow a low fat menu.In truth some fats are healthier than others and convenience food producers deliberately mislead the public about foods that contain them, successfully confusing them with lies which sound like truth.
High blood cholesterol levels can certainly contribute to arterial disease, increasing risk of heart attacks and strokes,but cholesterol in the diet does not of itself  cause high blood cholesterol - it is more related to saturated fat in the diet. However ,what is confusing to people is that saturated animal fats are also high in cholesterol so it seems that animal fats are bad because they contain cholesterol whereas the cholesterol is largely incidental.But now the food industry,which must be aware of what it is doing,has been able to claim or imply health benefits for non-animal fats.Palm oil is a vegetable fat which is relatively cheap and abundant, tastes good and produces a long shelf life. It is often marketed as containing "no animal fat" and "cholesterol free" although it is one of the unhealthiest high saturated fats you can consume.If the ingredients simply list "vegetable fats or oils" then it is likely to contain palm oil.Most packaged biscuits(cookies) and potato chips(crisps) contain palm oil unless specifically stated otherwise.The producers are deliberately trying to hide just how unhealthy these foods are.
Although not as directly injurious to body tissues as palm oil,the "fat free" deceit is a major source of the misguided notion that it is universally good to avoid fat in the diet.Unfortunately the absence of fat has two major consequences.Since the fat is usually compensated by an increase in carbohydrate most likely of the rapidly absorbed high GI(glycaemic index) variety : firstly these foods usually still have a high calorie content and excess carbohydrate is efficiently stored as fat; secondly, without fat the food no longer produces satiety.So you eat a rapidly absorbed low fat but high simple sugar food which is quickly emptied from the stomach and results in an insulin response which means that your sugar levels drop and you are no longer releasing good amounts of energy from the meal so you are tired and use less energy.Therefore,after your low fat/high GI meal you have stored fat ,are using less energy and feel tired and hungry.You can eat less than a thinner person and yet put on weight while feeling tired, hungry and miserable.The solution is to eat more protein,not to avoid fat(but healthy fats are preferred) and only eat complex carbohydrates,eg whole-grain(not even whole-meal) rather than white bread; bacon and eggs rather than cereal;fresh vegetables(fruit is less valuable) and smaller portions on smaller plates.
Whenever gestational diabetes is first diagnosed,the patients are educated about low GI diet and asked to have a half hour walk each day.They also check their glucose levels fasting and two hours after each meal.These are people who have usually struggled with their weight for many years and yet they all lose weight at least initially despite the growing baby.I used to ask them if they were getting enough to eat on the healthy diet and the answer was almost always yes.In fact most of these women who had previously been unable to lose weight despite intermittently starving themselves reported that they couldn't eat as much as was recommended because they were "too full".
The solution is available .There is only one healthy diet.It is the"weight loss" ,"heart health" ,"bowel cancer prevention" and "diabetic" diet containing good protein ,healthy fats and complex carbohydrates in smaller but more satisfying portions, with a little daily exercise.Sweet.

Monday, 13 June 2011

midnight

Light will be out before midnight for the first time in weeks.
As I wrote this my wife arrived home late from the airport after her flight was delayed by volcanic ash from Chile.I never thought that Chile would keep me from going to sleep at a reasonable hour.

fame

Not really having the answers myself, I asked my daughter what she would consider to be success and what she would do with it.If she had all the money and all the time in the world then what.Yes, you are the most famous person in the world, but what do you do with the minutes of your day?For me it would make little difference.I would still want to be part of a community, still deliver babies, still worry about being a good parent.It seems that I am already fully occupied with work, learning, family and a little exercise.More money would require more employees to manage it. More holidays would take me away from my work. I would feel useless and incompetent, although I must admit that it would be cool to have the opportunity to become fluent in French. Courament mon ami.However,as with most things, once you finally have it then I  imagine it is no longer so impressive.Helicopter flights to your private island could easily become tedious,staff management tiresome, friends untrustworthy and media intrusive.Wherever you are, you can still only feel with the same senses. If you are not cold, hungry or tired what does the view matter.I once lived for a year at the edge of a meadow which sloped gently down to a small river running through an idyllic Welsh valley There were hedgerows with stiles,majestic trees, cows, rabbits, foxes, robins and cute snuffling hedgehogs. Not to mention the hang-gliders,but that is another story.I loved the idea of our location but couldn't feel it, eat it, or bottle it and take it home with me. It was nice for the occasional walk, but nearly all of our cherished memories are from the people we worked with in the hospital on the other side of the fence.
My daughter is unmoved by my philosophy.She sees success as fame, and celebrity as satisfying work for those who enjoy it, as she would like to.She would happily spend her time dressing up and going out, and could ask for nothing more.She would just like to know which course you apply for to become famous.

time

Finally had a long weekend off work,from one pm Friday until eight am Tuesday.It seemed so precious that I wanted to do exciting and memorable activities in order to feel the value of this gift of freedom.Now it is nearly midday Monday and the time has disappeared as it always does, consumed by sleeping late,shopping,television and a film.With my wife visiting her sister interstate , both boys studying(you can at least hope) for medical exams,and my older daughter living her busy independent life,much of that time has been spent with my thirteen year old girl,a colourful exotic creature  somehow spontaneously generated within this very house.
Her interests and goals are foreign to me and yet I try to understand and share in them.Music is central to her existence,but by preference this would be only from the genre of popular songs by female performers and the occasional feminine teenage male.I said that a current boy celebrity reminded me of David Cassidy.She said,"Who?" And yet once he occupied the thoughts ,the emotions,the daily lives of a prodigious mass of young girls.With an admirable component of self-parody she says that she will marry this new shooting star,this idol of millions who actually lives on another continent,or perhaps a prince : another continent again but no obstacle to fearless teenage ardor.
Her time is most enjoyably occupied in conversation with her schoolfriends, girls of course.I can hear her animated voice as I type[ in my laborious slo-mo touch technique which never seems to metamorphose into                            
the fluent action of secretaries and young people].School is not the burden that boys endure,but a delightful opportunity to share thoughts ,ideas,speculations and gossip with her acquaintances -  though often blighted by teachers who misunderstand this most important purpose of education.I must concede however that friends who become pregnant,contract sexual infections ,get themselves expelled and wear unfashionable clothing or poorly applied make-up have provided far more learning this year than any class at school.They have also supplied that most treasured possession of a girl : the secret.
I recently read a book called The Female Brain (whenever I mention the title of the book people ask whether the author is male or female before considering its legitimacy).The author states that exchange of a secret results in an orgasmic reward response in the female brain as powerful as sex or drugs.This explains the attraction of gossip although I am unsure of its evolutionary purpose.Since women are generally more concerned with relationships,cooperative behaviour and the well-being of the group (or tribe) then interest in news(or tidings) and exposure of hidden information would perhaps enable women to better defend the cohesiveness of society. This reminds me of the traditional rhyme (of which there are many variations):"One for sorrow,two for joy,three for a letter,four for a boy,five for silver,six for gold,seven for a secret never to be told." Originally related to the number of (European) magpies in a group, it has also been adapted to crows elsewhere.
A group of magpies can also be called a tiding or a tribe.
Years ago a hard-working friend was surprised when his son had serious behaviour problems despite a stable and supportive family.It was eventually determined that despite often occupying the same space there was very little dedicated time together.The solution was to arrange a joint undertaking for just half an hour a week without any of the other children present,the details to be mutually agreed.A similar plan was set up for the benefit of the other siblings.Group activities were still valuable but did not count as part of the treatment and neither did fortuitous co-occupation of an area.It had to be an organized commitment.My understanding was that the strategy was a success,so I decided to do the same thing.Each week each child had a guaranteed half an hour with their father often at bedtime,often including the reading of a chapter of a book,but sometimes a weekend activity.If I had a week off in school holidays then each child would have their own day.After four of these days my wife would want her own day with me and also compensation for the fact that every time I was with one child she had up to three of them.However, she was supportive of the concept, although whether it is as important for the girls and whether it has been of any value at all can never be proven(or proved,since both are past participles of to prove,although only proven is also an adjective and that is a proven fact).As it happened, the girls have certainly  managed to use the allotted time to buy some clothes.
As the children have left home one by one the system has declined until now there is only one.I fear she may receive too much of me rather than not enough so I try to be a little more like my own father who had just the one child.He would sit in the kitchen with a cup of tea, unfiltered cigarette and cryptic crossword,simply available to listen,though not above a little Socratic irony.I would gravitate to the kitchen and conversation with my father like the cat who always seems to find his way to whoever is still up at night.I would complain about the stupidity of people and he would encourage me to elaborate.This can also be known as getting enough rope to hang yourself.This is said to be an educational method but I am not sure how much I learned .The only advice he ever gave me was to try to be more tolerant.
If I was talking to him now I would complain about the progressive erosion of meaning in words such as irony,where situational irony is now just coincidence or incongruity,and literary or verbal irony is no more than sarcasm.I know that the language is constantly evolving and complaining is pointless.I think I am more tolerant but fear that I haven't really changed.
If my father were still alive and watching he could temporarily remove the cigarette from his lower lip,take a sip of tea,then turn to my unseen audience and, in a true example of dramatic irony,tell them that I could yet be a little more patient.If only time had not taken him away.

Thursday, 9 June 2011

4 am

It wouldn't be so bad if I didn't have to wake early and concentrate at work all day.There will be no relief,no respite.Whose fault is this?