Sunday, 10 June 2007

Holyrood Park, Royal Mile And Fudge

The amazing thing about this large 650 acres of charming wild land containing lakes, cliffs, hills and an extinct volcano is its proximity to the city centre of Edinburgh. Thanks to the lovely Kim for showing me the way and literally within 15 minutes of walking, I found myself leaving the hustle and bustle of city life and immersed in mist, muddy grass and majestic crags.

Soaked in sweat from the humidity I huffed and puffed my way to every single high point in the park, as is my habit of wanting to view things in a grand panoramic scale from up high, whether it be from Arthur’s Seat or the Salisbury Crags.

Hikers hiked, picnickers picnicked and dog walkers dog walked in the refreshing mountainous air and quiet solitude. I have not come across a European city that allowed you to do all that and still make it back within an hour of walking to piss in a Starbucks toilet.

As I descended parched and hungry I avoided the monstrously exorbitant Holyrood Scottish parliament and made a detour for the Royal Mile. Running from the Palace of the Holyrood House at the bottom end and rising successively upwards towards Edinburgh Castle, this cobbled historical street draws a vast number of visitors from across the globe enunciating anything from gobbledegook German, impetuous Italian, flirtatious French, crazy Cantonese and North American English.

With the sound of bagpipes perfunctorily wafting through from many a tourist trap, it’s the last variety of visitors that laps up all the authentic Scottish knick knacks brazenly displayed to lure the gullible and na├»ve. Colourful Kilts? Check. Bogus Bagpipes? Check. Scotch whisky? (it’s an experience) Check. Your Family History for only £10? (ORLY?) Check. Kids swords and axes? Check. Loch Ness Monsters? (in 3D too!) Check. After all, there is no need to visit the rest of Scotland when a quick walk down one street covers it all!

It was a lovely warm afternoon and street performers were out in force, tourists mingled with the locals and drinking glasses chattered from the cafes and bars. My snarling stomach made a detour for the mouth-watering Fudge House where a delectable array of neatly stacked blocks of condensed sugary goodness beckoned hypnotically at me from behind the glass display. Especially the words “Triple”, “Dark” and “Chocolate”. Mmmmmmmmmmmmmm.

Paralysed by an array of displayed rectangular choices I asked what were the best sellers. The young lady explained that it varied from day to day. But usually it’s the Triple Dark Chocolate and yada yada yada….who cares? I was right!

Happy with my purchase, I walked away and ravenously devoured my saccharine ingot…OMG! It was sooooo gggggggggoooooood! I immediately back-tracked and apologized that I was really a chocolate fiend and asked what was the second best seller. Hazelnut chocolate. Hazelnut chocolate fudge it was. OMG. I swear, chocolate is the second best food invented. EVAR.

I’ve seen most of the historical gems on this beautiful street many moons ago thus I spent most of my time wandering from shop to shop and people watching. I did pop into the The High Kirk of St Giles to admire the stained-glass and austere interior and was fascinated by a photographic display contributed by locals on how they perceived their own city through the eyes of their cameras.

I checked out the Fringe shop and thumbed through the glossy programme for the upcoming festival and felt even more overwhelmed by the array of choices of events then at the Fudge House. I wended my way thoughtfully back to Waverley train station, past the television crew and photographers awaiting for God-knows-who to arrive on the platform.

Well, August here I come!

Burberry turban and tartan suspenders. I kid you not.


Surprisingly it wasn’t that long ago when American surgeons played the important mid-wife role to the concept of offering clear protocols for managing major trauma that allowed doctors to deal with complicated clinical situations in a controlled and structured way. Advanced Trauma Life Support (ATLS) is now regarded as the common international language of trauma care and the course has trained over 700,000 doctors worldwide in over 50 countries.

My ATLS certification was going to run out later this year and I was fortunate enough to secure a place on a course in Edinburgh when a candidate dropped out at the last minute. I remember the time when a two-year despairing waiting list was the norm for what was then not even a requirement for surgical trainees but I had the foresight to know the impact and importance it was going to make and had always got myself certified.

Thanks to the internet, I was able to rapidly assess what upcoming courses were available and I made my intentions (erm, enthusiasm) clear via a mass e-mail campaign (heh). The fact that I stressed I could pay pronto and was available immediately put me at a distinct advantage – availability in cash and person always got the desired attention.

The setting was the Lister and the usual mixed bunch of ATLS provider candidates consisted of doctors from specialties ranging from General Practice, Intensive Care, Accident and Emergency, Acute Medicine, General Surgery, Orthopaedics and Trauma and Anaesthetics, and grades from FY2s/SHOs to Consultant level, with half a dozen nursing staff from the Royal Infirmary of Edinburgh as observers.

After the registration process of having our mug shots taken by digicam and candidates tentatively getting to know one another over bladder bursting cups of coffee and cold Saran wrapped sandwiches we had the welcoming talk given by our enthusiastic host followed by brief introductions from each member of the Faculty board. I forgot how it had always been de rigeur for each candidate to stand up in front of everyone and give an impromptu introduction of themselves, and (here is what I like) tell everyone something unique or interesting about themselves (mine: I almost made it to Everest Base Camp…..pfffffffffft) – which was a great way to break the ice in later social settings.

After the familiar important ATLS mantra of A, B, C, D and E (Airway maintenance with cervical spine immobilization; Breathing and ventilation; Circulation with haemorrhage control; Disability: Neurologic status; Exposure/Environmental control: Completely undress the patient, but prevent hypothermia) was drummed into us, the audiovisual lectures whizzed by in rapid succession. I found the more memorable talks had audience participation and simple audio-visual aids to reinforce key messages: to wit, three candidates having a race squirting into a bucket from a short, fat needle, long venflon and an even longer and thinner CVP line attached to syringes full of dihydrogen monoxide to illustrate Poiseuille’s law.

The enjoyable parts (beside the social) were when we as candidates got to DO things. The skill stations were fun as it allowed blood to circulate around our brains and hands instead of our sedentary feet and where techniques such as surgical cricothyroidotomy, endotracheal intubation, chest drains, CVP line insertions, log rolling and practice moulage got going. Reading about something is one thing…it’s only when you get to do something do you realise the nuances specific to practical procedures that you can’t glean from a page of text. It was imperative that everyone should have thoroughly read and highlighted to death the creased and spine destroyed bended manual before attending the course to get maximum benefit.

I noticed the more dramatic procedures of diagnostic peritoneal lavage and pericardiocentesis got relegated to a discussion level when these were actively taught as a procedural skill in the past. But I always thought the chances of an average ATLS provider getting to do these in real life to be unrealistic (I have done a pericadiocentesis only once on a cardiac arrest patient) as the availability and ease of skilled specialty help and imaging such as spiral CT and ultrasound scans in a hospital setting becomes more accessible.

Giovanni’s restaurant (oddly situated on the top floor of the Lister) was the setting for the social. Everyone was friendly and easy going and stories and anecdotes were exchanged over glasses of wine and pork (absolutely perfect for me *rolls eyes*). It was unsurprising that topics such as the recent MTAS debacle and mini-exodus of doctors to other Anglo-phone countries had to rear its gorgeous head.

Oh, the last day with the written exam and moulage was…GREAT FUN!! To coordinate and use all the principles one had (supposedly) learnt in a test situation was actually stressful on the spot. Having a clear, cool calm head, be able to think logically, be able to make sure that each part of the ABCs were effectively managed when identified, skilled help was called when needed, necessary investigations ordered and constant re-evaluations were done were all keys to not screwing up and unwittingly “kill” your patients.

I think such a course should be mandatory for all whose work deals with trauma patients (well, that is pretty near much all doctors then – at least when they start their careers) and should be introduced on a basic form at the undergraduate level. But there is always the question of time and funding…I was surprised that all the FY2s had to fund their own course when not too long ago study leave budgets at least offered a financial buffer. But such is the state of the beleaguered cash strapped NHS these days. Although at times the moulage scenarios were artificial and contrived, it was a necessary evil to force the candidates to think through the principles in order to see and apply them in action so that in real life, everyone will understand and be talking the same vocabulary when both assessment and resuscitation goes on simultaneously by a team in the resuscitation bay. I like the beautiful logic inherent in the system of patient assessment and management.

Thanks has to be extended to the administrative and catering staff and to all the volunteers who gamely got themselves into make-up mode of wounds, cervical collars and splints, and role-playing combative or near moribund patients as the situation demanded in the moulage. And finally extra thanks has to be extended to all the accommodating, enthusiastic and good-humoured faculty staff for taking time from their busy clinical schedules to teach another rag-tag bunch of plebeians to make the world a safer place.

Saturday, 2 June 2007

Boing! Boing! Boing!

Earth continues to revolve around the sun this week. And apparently Summer’s here and the time is right…for trampolining in the garden. Now the days are longer (thanks to the planetary tilt) and toasty (thanks to global warming), I see more and more young ‘uns with banana shaped arms and legs after misadventures with their favourite family entertainment centrepiece: the trampoline. It’s apparently the “must have toy” for the summer and is reportedly the third most wanted gift for children aged 5 to 13.

It never really struck me how popular it was until the mental link of seeing backyard after backyard after backyard of trampolines whizzing by me from the train window in the NE of Scotland and the concomitant relatively high frequency of injured limbs from such activities. I do hope more parents take the time to realize the full implications of their purchase and take reasonable precautions instead of assuming their kids knowing how to use the damn thing properly.

And here’s a popular American home video of a trampoline accident that’s been circulating the internet…(what are friends for eh?)

And it’s not only kids. Nocturnal high jinks (ba dah bum) by inebriated adults who aught to know better had resulted in at least one chap whose sprightly springiness launched him into orbit over the garden fence and into his neighbour’s backyard, shattering both his legs. He was crying both in pain and laughter when he realised how ridiculous it was.

In Tameside, where I’ve lived and worked before, sometimes despite adequate supervision, freak accidents do occur and this can give rise to the parallel claim culture.

Oh, and to cap it off…this is PURIFIED LIQUID GOLD from the most recent episode of The NOT to sell a trampoline…LMAO!