Why working with doctors can induce hypertension.

Whenever my Manager at work asks me to go to the ward to set up a patient with overnight ventilation treatment, I internally groan. This reluctance is the direct result of a combination of three things:

1. The patient is too ill to comprehend, hear or understand what I'm saying. In a role where communication is key, having difficulty channelling information seriously sets me back, normally on time (and sometimes on patience). I don't have anything against ill patients, most of them are lovely people, but when you've already been rushing around all morning and stressed all afternoon; facing challenging patients is the last thing you want.
2. The doctor is annoying. This has been the case usually. I have worked with only a small range of doctors, but in each one I found something to get annoyed at. If it wasn't egotism, or mismanagement, or even ignorance, then it was definitely the doctor's negligence towards the patient's mere presence, if not mine. I remember one actually talked about how I was going to do my job without even introducing me to the patient or the patient's translator. Actually there was one that I found tolerable, and that was because he didn't say much but actually asked questions as opposed to acting like he knew it all. 
3. The patient has run away smoking and no one in the entire hospital can track him down, even after several hours of absence. 

My ward work this week had to spread over 3 days. The first day I was told by my Manager that a patient at a different hospital needed an emergency sleep study done. Normally we don't do such things as the studys need to be booked in advance as the sleep centre only have a limited number of ambulatory recording devices used to study the patient while asleep. However the patient was moved to our hospital and I was sent to wire him up. A consultant had demanded it be done, so it was done, and done it was. So I went, and did it, but I felt sorry for the patient because he had to be wired up 6 hours before he actually went to sleep. The patient, thankfully, did not complain.

The next morning I removed the wires and immediately analysed the data. What I saw was one of the most severest forms of obstrucive sleep apnoea I had ever found, it was right up there in the top 3 most severe OSA cases I had ever analysed (Oxygen saturation level would drop into the 50% range occasionally). Poor man, I couldn't even imagine how he lived! I talked it over with the consultant a few hours later during which he spoke to the registrar on the ward, five minutes later a request form was placed into my hands to set the patient up on treatment. I told the doctor in the same instant that I would be at the ward before four pm. This was at 14.30.

I get to the ward in a rush because I had so little time and so much to do, but I reached the ward at 3.35. I went to the patient' bed to find... a bed. No patient either ontop, beside or under it. I searched the room thoroughly.

I ask the doctor 'Where is the patient?'
She replies, very nonchalantly 'Oh he's at the eye clinic' and proceeds to call the eye clinic immediately. 'How long can you stay?'
'5 minutes.' I say, not being annoyed yet as I'm thinking of getting home in time for my driving lesson (which got cancelled due to drained petrol stations).
'The patient's on his way up.' said the doctor when she finished talking to whoever was on the line.

So I wait for the patient, 5 minutes later and I remember that I told the very same doctor that I would be down before four... so why did she send him away???? 10 minutes into the waiting game and I tell another doctor (the registrar) that I am  leaving and that I had warned the doctor previously of when I would be arriving. I don't normally like the registrar (he explained a patient was dying to me right in hearing range of the same patient) but he was sympathetic and asked if there was anything he could do.. maybe he could set up the patient on a ward CPAP? I declined politely as I honestly did appreciate his sentiment; saying the patient wasn't going to die without one night of treatment.

Guess what the registrar did?

The next day I called the ward in the morning, saying to God knows whoever I was talking to, that I wouldn't be able to come in the morning as I working two people's shifts (understaffed should sooo be the NHS middle name), I would be there in the afternoon.

I manage to get there in the afternoon. I knock on the patient's room door, to get no reply, I knock a little louder calling out a subtle 'Hello?'. Getting nothing, I walk in warily to find the patient snoring, fast asleep; a clear sign of symptomatic OSA. When I woke him up, the first this I hear is a complaint about the ward CPAP, how it was uncomfortable and how it was at such a high pressure he felt like he was choking. I restrain myself from shaking my head. There is no point saying 'No' to a doctor.

I set the patient up on long term CPAP and I quickly understand the patient has not been given any details about his sleep study results. So I give him a brief overview; warning him that he might not want to hear the figures. But bless, he was as excited as a golden retriever and even fetched a pen and paper; enabling him to write down what I said. I spent nearly an hour with him, he told me of what appeared to be the doctors emotionally blackmailing him into using CPAP and about how he was at risk of stroke... bla bla bla.

You must understand that the main complaint of this patient was severe headaches... Considering that a sign of OSA is headaches, even when the O2 saturation level only drops by 7%, that a pretty bad headache might appear when the sats drop by 20% for most of the night and 40% for the rest. But no, further investigations were carried out during the course of the day and the patient had to have three (possibly unneccessary) lumbar punctures to analyse CSF. Oh how I felt for this poor man.

He was to be moved back to the former hospital by the neurologist's command for extra tests. Maybe I'm being too blase, maybe this man has an intracranial tumour, I don't know and neither do the doctors. But shouldn't a painless investigation be considered and done before more invasive ones like lumbar punctures If the evidence suggest so? I don't mean to sound arrogant, but I'm pretty certain his severe OSA is what is causing his headaches, so shouldn't the patient be left to try out the treatment in peace????

Arrrgh... the pain... the wasted money... the politics of it all. So silly.

I feel...

I have a pretty important week this week, I'm pretty nervous.

I've been under quite a few different emotions for some days now. Irritation, anger, sadness, excitement even a sensation of well being.

I am irritated because I feel walked upon, a punch back, the push over.

I am angry because I know all these things and don't do anything about it. And when I do snap, I feel ashamed for upsetting the other person.

I am sad, but sometimes happy. It's strange, I can't really explain it... like feeling hot and cold at the same time.

I am excited because I will be giving an important presentation all about Manga! And I will be going on a much needed holiday next month.

I feel well because I've discovered a vast amount of beautiful land that is literally 30 feet away from my doorstep, walking through it with miss short fuse for 2 hours was wonderful and exciting. Like being a small child and being brave enough to stray from your parents far enough to start exploring.

Last night, more than anything, I was physically fatigued by my family, I'm too old to endure their selfishness, accusations and battles. I just wanted to walk away, as cowardly as that may sound, it probably would have been the best thing for all of us. I'm tired of playing the peacemaker and getting nothing for it.

Quick Midnight Rant

CPG = Central Pattern generators, responsible for rhythmic locomotion like walking or swimming. No need for sensory stimulus or commands from cortex/descending tracts of the Spinal Cord.

CPGs were firstly identified in invertebrates such as the tadpole and Lamprey (what the hell is a lamprey?)

Glycinergic = inhinbitory (maintains Left-Right alternation)

Glutamatergic = excitatory (maintains Left-Right synchrony)

Blocking GABA receptors affects rythm, hence, anatgonising them will cause higher frequency of motor output.

GABA important in patterning locomotion in early embryonic life.

GABA later replaced by glycinergic inhibitory systems, and glutamatergic excitatory systems.

I'm supposed to know much more than this.

Dessa's Ultimately Mega Huge RANT!

I can't get sleep! Isn't this enough reason to rant? I hope my dear audience will oblige me one more time, in allowing me to rant my heart out.

1. I can't sleep!!! Oh... I've already said that. Well, I'm sure you can't actually understand the full extent of thse suferings with me saying it only twice, soo: I CAN'T FRIGGIN SLEEP! 'Why?' I hear you say, well, mostly because I have the most horrid thoughts plaguing me when my mind is ment to rest from all thought, these thoughts I'll be explaining later on.. but somehow my mind branched out to the vision of Gollum.. naturally no-one would even try to sleep when his ugly face is stuck in your mind.



2. I can't get a job! At the beginning of my job search, I said to myslef 'I can take a few rejections' and I was right, I can only take a few, not a heapful. It's not like I'm dying by these rejections, It's just been a very long time that I've been job searching and I have patience, but there has not been a shred of good news, just continuous darkness. There's only so much rejection I can take before my own esteem turns on me and shrinks the way water slips from cupped hands. As a result, I've become bitter, jealous and sour, refusing to communicate with friends, not wanting to go out or see anyone (I have Miss. Hepburn to drag me out though). I know my friends mean well when they ask me how life's going and what I have planned, but I feel so low about it that I blow off everyone who asks, afraid of what they might think or say...even though it can't possibly be worse than what's going through my own head. It's precicely what runs on my head that plaugues me so when I lie my head down to sleep, I feel so trapped by them, like they force me into a box of restlessness.



3. I'm stuck at home!!! I'm starting to consider being stuck at home for the past 3 and a half months as nothing short of punishment. With no intectual stimulus, my mind is actually rusting and diminishing, I'm worried I won't have two brain cells to rub together by the end (whenever that will be!) It is mainly for this reason I so want a job, just something to challenge me, to feel like a member of society, to make my brain function!

4. I'm so silent! I've taken to not really saying much at home, mostly because I feel lke I have to fight with Miss. Sort fuse's ears to work and listen to me. That's IF shes not already talking to one of her kazillion friends, (usually this is Miss. High Heels, but I like her, so it's all good). The efforts I've had to employ myself wih in order to be made heard by Miss. Short Fuse has resulted in a false reputation of being 'clingy'. Well excuse me! I'd try and vent my speech energy on Miss. Pain in the Ass, but like I've said before, she's incompatible with the human race (though deep deep deep deep deep down she's actually a nice person). So yes, I'm now a mute.

5. It's ramadan so I feel kinda guilty about ranting as I'm supposed to be calm and patient and forebaring :( Which I'm not exactly exemplifying right now... so yes, I'm feeling guilty ontop of everythng else.

6. I am unable to complete my writings. I have started 3 works of literature, and I simply cant finish them, which is a certain cause for annoyance to me. I think there are several reasons for this; the switching from plot to plot will obscure focus and so I am unable to think straight; I keep adding to plans and plots after I start writing, so it requires rewriting alot of the time and finally: I don't get enough time on the computer to write much.

In conclusion, I'm not too good, but I am happy it's ramadan, I hope my friends can understand a little of why I'm considered anti-social at the moment, probably for more than just at the moment (Mss.Tooting remarked this to me recently). But with Allah's help, things will get better ^_^

Manga of the Month August

It's taken me quite a bit of thinking to choose what manga to review this month..... I wanted to review a shonen (boy's manga) as I've been talking a lot about shoujo manga for a while. But I just can't help myself. I have been holding myself off ranting about 'Nana' for a long time and I think now is the time to do so... only because I'm so upset that the new chapters have not been released yet :(

Well, 'Nana' is my all time favourite manga drawn and written by the prestigious Ai Yazawa. There is only one manga of hers that I haven't read, she is to me, nothing short of amazing. Her drawing style is very unique, but in each of her different works there is distiniction, I think she did best in 'Nana'.

The manga is sorta a fashion manga as it experiments with different types of clothing styles and has everything from the punk to the baby. I have met people who have started reading this series and stopped, because they got all 'emo-ified' so it can seriously grip you. For those of you who are pretty inclined to adddiction, maybe you should stay away from this one then.

'Nana' is about two women who are both called Nana and they're friendship, however, they are very different and come from very cross-dimensional backgrounds (not literally). One of them was in a normal family unit, pampered and loved, while the other was abandoned by her mother and left to live with her grandmother, who died when she was 15, so she had to start caring for herslef at a very young age.

I could spend hours and hours typing out the storyline, but that would ruin everything for you, so I'll stop here.

Just Joking :p I won't let you off that easy.

The main thing that one should know when considering this manga though, is that despite the unusual storyline, it depicts life and human relationships in its true and realistic form. There are disappointments, there is sadness, and betrayal. Things that do occur in life.

I like this manga the most, not because I'm a mad fan of the mangaka, but because you see the maturaion of the pampered Nana, she adjusts to the hardships of life that she had been too childish to understand of before, and more than anyone in the the entire series, she is the one that scarifices most for what she believes is right.

For those manga haters for the sake of ignoring my rants, the series has also been made into a film (with real life 3d human beings) I haven't watched it as nothing can be as good as the origiinal right? But this picture looks pretty good that it seems promising.

I've meaning to do this for some time.

I have stuff that I need to get off my chest. So here goes.

1. HOW CAN EGYPT BLOODY WELL WIN 1-0 TO ITALY BUT LOSE 3-0 TO USA?????????? STUPID FOOTBALL TEAMS!!! But I have to give Egypt credit for losing 3-4 to brazil, it was a brilliant match to watch, we could've drawn or even won the match, but it was not in our naseeb.

2. Mad people: if you're trying to be drunk could you not point at me from your car window and say 'WAHAAAAAY' as if to confirm to the world that you can decipher a muhajiba woman from the crowd. It makes me laugh but not when I'm in a bad mood, so stop it please.

3. Miss Short Fuse: I request that you stop being such a slothful git and actually earn you're way for favours, rather than make me go out to the supermarkets and make your dinner the moment I get home and wash up the dishes in the sink, while you're still happily chatting away on the phone. Your presence is wasteful and insulting to life.

4. Miss Pain-in-the-ass: Please open the windows at night, I've been waking up in a pool of sweat every morning for the last three weeks, and I know you consist of zero consideration for the sick and ill, but if you could stretch that tiny bit of generosity you own, to allowing the openning of windows, then my opinion of you might increase a millimeter... perhaps.

5. Bad bred parents: listen to the people around you, despite being ass holes, you are still loving towards your children, so stop being stubborn and listen to other people's opinions, their aim is the same as your's. So stop making decisions to show your 'authority'.

6. I'm angry.

7. Miss In-her-own-world: I've given up the thought that you can act as a responsible adult.