this and that

Saw a young woman with intellectual disability who had uncontrollable epilepsy associated with areas of cerebral atrophy.  She has been free of seizures since excision of a temporal lobe and hippocampus three years ago.They are hoping I can help with her constant slight urinary incontinence. It is probably a cerebral problem, but all possibilities are being investigated.
Asked if she had ever had sex she said, "He tried but he couldn't do it."
Although twenty three years old  she attended with her guardian who asked her why he couldn't do it. She said, "Because I didn't let him." This was all news to her guardian - I think they might have more discussion on the way home.

Too busy for lunch then ran to the labour ward for a GP having a difficult delivery. The head was nearly on the perineum but the vacuum cup kept detaching while the baby's heartbeat was difficult to detect. The patient had an epidural so couldn't push very well. The head had rotated enough to apply forceps which still required some effort as the shoulders were stuck. After some manoeuvres the large baby was delivered in good condition with the perineum intact. No tear but a lot of tears.
After the birth,the patient's mother said that she had watched me deliver her other daughter with forceps only two weeks ago. I thought she looked familiar.

hug

Just delivered my tennis teammate's wife. He gave me a hug after the delivery.

rainbow and cherries

An electrical storm rampaged through tonight, cutting the power repeatedly, and then it left a rainbow.

One end.

The middle.

                                                   










                                                                                                           

                                                                                     

                                                                                                                   The other end.      


 It freshened the trees.

Sunburst Gleditsia

Ruby Lace Gleditsia
                                                                                               


                    It formed rivulets down the driveway.                                                  

Looking back the sun was setting,

while an unusual light glowed in the wake of the storm.

Walking back to the house I found cherries on our tree for the first time in fourteen years.

blood

Delivery by GP at seven thirty p.m.. Called me at eight thirty. Bleeding. Not stopping. Had oxytocin, ergometrine, misoprostol, but possibly still some placental tissue in the uterus, so arranged removal of retained tissue in theatre.
Patient very pale but apparently blood loss is only a litre. I don't believe the measurement and ask for a blood transfusion asap. The anaesthetist agrees. Under anaesthetic a small piece of placental tissue is removed along with large blood clots. The midwife rings to say they measured a further three litres in the bucket. She certainly looks pale but there is no further bleeding and blood is on its way. I leave her with the anaesthetist and GP and go home.
I cannot sleep so I read my book - Birdsong - about the first world war. It is very graphic and gory. I feel as though I am soaked in blood. At one a.m. the phone rings. The bleeding has recommenced. More blood and misoprostol is ordered. Arrangements for transfer to the city are begun while I come in to to insert an intrauterine balloon.
The balloon is not easy to insert properly. It is inflated and deflated repeatedly until finally it is in good position. The bleeding stops. She has now lost over four litres. Blood is smeared on my white shirt. I sponge it off then go home when the emergency transport team arrives. She is pale but still conscious.
Later, reading in bed to wind down, the book ends in a mixture of bloody defeat and unlikely optimism. I turn off the light at five a.m..
At seven the city registrar rings for further information. The patient is still ok. I sleep for a little longer then  
go to work in the clinic. While I am seeing my first patient there is a phone call from the patient who had the cervical laser treatment. She started bleeding five hours after the treatment, hasn't been able to sleep and has soaked two bath towels with blood. I ask her to come in at once.
On the examination couch copious blood clots are removed from the vagina and the cervix exposed. I was hoping for a single bleeding vessel but there is just a general ooze which I oversew with a nylon suture then add Monsel's solution and silver nitrate. There is only a slight residual bloodstained discharge but I am concerned about a further bleed. She will ring me in a few hours with her progress.
The clinic continues without lunch.

new laser

Laser: Light Amplification by Stimulated Emission of Radiation (electromagnetic radiation, i.e. photons).

Tried it today. Second hand but still expensive. It works well though the case was difficult due to bleeding.

Now to see if funding is approved or buy it myself.

sunny day

Everything is better when the sun is shining.

enough

I am tired of it all.
My wife hates Christmas. It is only November but it has started already, so predictable.
Nurses are striking. My major case was cancelled. I can't judge but everyone seems to want conflict.
I don't know if  I am tired or depressed, if I need a holiday or medical treatment, retirement or a kick in the backside. I just don't feel like working.

I have been thinking about motivation, thinking about our neurological reward system. I imagine that, every time we act, we ask it if it will make us feel good. I wonder if I can ignore it and continue to do what I have planned, or perhaps that is still the reward system in action - telling me that there is more pleasure in following the plan. Or, perhaps I can ignore the reward system for a while but will suffer the consequences later, such as depression or lack of drive. Maybe that is what is happening now after working too much for too long.
 Or maybe it's just Monday again.