big news this weekend seems to be this big attack on westerners by alqaeda militants and subsequent hostage crisis in khobar, saudi arabia. ultimately, the pric of oil will go up. already at over $40 a barrel, we could be looking at 92p instead of 72p very shortly. hmm...

listened to:

"breaking the habit", linkin park. really good track this one. off their "meteora" (warner bros, 2003) album. groundbreaking video too, produced by gonzo digimation and directed by renowned anime illustrator and animation director nakazawa (kill bill: volume 1).

food of the day:

braised chicken, stirfried broccoli, rice congee

posted by Chas at 23:35
go ahead, roll the donut!

 
ugh... just got back from dimsum and im streaming like hell. pollen count is supposed to be low today and i even took a terf last night, yet just this short exposure time over lunch will now leave me feeling like shit for the rest of the day. there goes my bank holiday weekend... =(

food of the day:

assorted dimsum with puer tea (a popular chinese black tea), peninsula chinese restaurant, north greenwich

listened to:

"everybodys fool", evanescence. finally! my fav track from their debut "fallen" album makes it to single release. theyve waited long enough! uk release 31/5/04.

posted by Chas at 16:26
go ahead, roll the donut!

 
oh boy... last ever friends tonight (season 10 finale). predictable i guess, but still fairly moving nevertheless. final stories fitting in several ways:

- ross and rachel were always gonna be together, you just knew it.
- the show started in central perk, so only right to finish in central perk.
- the destruction of the foosball table, an icon of practically the whole life of the show.
- chandler gets the last word of course. who else!

i think im gonna buy the whole lot (eventually). most of the early season box sets are now going for £22. one of only a few shows that ive been a dedicated fan of.

however, from a high to a low...

big brother 5 started tonight. ugh... need i say more?

food of the day:

fried battered cod, mash, baked beans

official wb friends site
official nbc friends site
official big brother site

posted by Chas at 23:53
go ahead, roll the donut!

 
just finished for the day. spent all day in day surgery, am ent list and pm dental list. pretty straightforward anaesthetics for all these boys, mostly young and fit people with no medical problems.

good. finishing early means i can catch up with todays news...

so i see that this radical muslim cleric dude abu hamza has been arrested this morning at his home in shepherds bush and is now at (the usual) paddington green, awaiting a trip later today to the magistrates court at belmarsh. looks like hes facing extradition to the states, where us attorney general john ashcroft has said in new york today that hes an alqaeda suspect. hmm...

food of the day (dinner, on way home from work):

roast duck soup rice vermicelli and wonton soup noodles, wong kei, chinatown

posted by Chas at 16:31
go ahead, roll the donut!

 
nice one. just watched double bill of er, the two eps before next weeks season finale (10.20 "abby normal" and 10.21 "midnight")... from the trailer last week, was expecting "midnight" to be really poignant, in a "first snowfall" (9.8) or "the letter" (8.20) kinda way. kems stillbirth story was good, but wasnt actually that moving. hmm... lets wait and see how the season ends next week...

spent all day on a gynae list. supervising consultant happened to be one of my old cardiothoracic icu bosses, so he knew me and basically just told me to get on with it! *gulp*

managed to take them all down and bring them all back without problem. some were what he called "intermediate" cases too. wow.

food of the day (not enough time to finish at lunch, finished for dinner):

southern fried chicken, cheese & onion quiche

official wb er site
official nbc er site

posted by Chas at 23:14
go ahead, roll the donut!

 
wahey! finished this afternoons list early (the thrice weekly acute gynae list). was done by 4. getting slicker with airway control. forearm musculature more and more toned. only thing was... blew three veins during cannulation. this never happens when i cannulate. grr... guess im just not used to using 22g, being more accustomed to larger calibre lines in emergency medicine i suppose.

so i see that "shrek 2" (andrew adamson/kelly asbury/conrad vernon dirs, dreamworks, usa, 2004) is up for the palme dor at cannes. this will be the first time in the festivals 57 year history that a movie and its sequel have both made it through for jury selection.

hay fever seems to have settled today, seeing as the recent heatwave is over and its now gone chilly again. which is just as well, considering the amount of obscenely obese midriffs being paraded around all of a sudden in those few hot days. this british obsession with revealing all at the slightest hint of sun, all this sudden excitement... whats with that?

right, off now to join the general icu guys for vanessas leaving party...

food of the day:

fried battered cod (its friday after all!) with lemon, mash and peas

posted by Chas at 17:01
go ahead, roll the donut!

 
got to do a whole list today with me doing everything and the consultant just watching. all went smoothly.

started to pour down all of a sudden as i left work today. hasnt been like this for a long time. so this heatwave is over. getting chilly again. hid in the kebab shop while waiting for the rain to stop...

i see lord coe has taken over from barbara cassani as chairman of london 2012, a day after london gets "candidate city for the 2012 olympic games and paralympic games" status from the ioc. having made it through this first cut (from 9 to 5), i really hope london gets it. we need this. madrid, moscow, new york and paris are also still in, rio de janeiro, istanbul, leipzig and havana are all now out.

also in the news today was the fact that tony blair got flourbombed yesterday in the house of commons. haha

so jelena says her sister is "shorter and has bigger breasts". met this sister today. she wasnt that short and her breasts werent that big either. *shrug*

food of the day:

the usual. chicken shawarma kebab with chips, extra sesame sauce.

londons bid to host the 2012 olympic games and paralympic games

posted by Chas at 23:19
go ahead, roll the donut!

 
wow. first hot weekend of this year. reached 22c at heathrow yesterday. today similar, lots of sun. hay fever starting to play up now. always starts around first week of may, lasting for two months until the start of july.

so the gunners have done it, unbeaten for the whole premiership season, first team since preston in 1889 to do so. truly historic. proud for the league champions during todays parade from highbury to islington town hall with their trophy. now we just have to win the champions league next season...

also on a historic football note, south africa landed the 2010 world cup for the first time in africa yesterday, ahead of morocco and egypt (tunisia withdrew and libya were discounted earlier). this after the fiasco in 2000 when world cup 2006 hosts germany were selected. in the words of fifa president sepp blatter in zurich yesterday, “the winner is africa. the winner is football.”. too true.

posted by Chas at 23:18
go ahead, roll the donut!

 
awesome. still in being made to get my hands dirty in my first week mode, i got to anaesthetise the whole of this afternoons day case bum list. ok, so they were simple day cases and they were quick bum surgery cases... but hell, we all have to start somewhere. feeling pretty good.

also feeling pretty hungry. think ill get noodles for tonight. must make sure of two things... need to pick up my free coffee for today and need to get back from chinatown in time for er.

food of the day:

- coffee from ritazza at victoria station, free, in association with metro newspaper as part of london coffee week
- roast duck soup vermicelli & wonton soup noodles at wong kei in chinatown

oh, interesting site to check out, for those of us 80s coinop video gamers:

pacmanhattan

posted by Chas at 17:32
go ahead, roll the donut!

 
well, first day on the job as an anaesthetist...

totally not accustomed to this kinda work. different world altogether! having been used to being in charge of the chaos in the emergency dept shift after shift with not that much backup, the world of anaesthesia appears positively bizarre, with this air of calm and mellowness, constant supervision, even occasions when the boss tells you to leave theatre and go take a break! could get used to this... =)

bunch of interesting anaesthetics to open with... 19 yearold with a large submandibular abscess needing incision & drainage, potentially difficult airway and intubation, who actually did relax with propofol to take a rae nasal tube quite easily... 31 yearold incarcerated inguinal hernia using laryngeal mask... 91 yearold fractured neck of femur using spinal...

not bad for a first days learning.

food of the day:

doner meat and chips, large

posted by Chas at 22:39
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back from night out with jess and maggie in clapham. never really liked that area, but wasnt my choice. full of pretentious hello! magazine reading superficial hair straightener types. ugh...

waited at the bar in some club called revolution for 20 minutes while some plonker in a red check shirt and some chick with her tits hanging out both got served in front of me, despite the fact that i had been there before them. bastards. just goes to show... next time in a fucking trendy bar like this, ill need to make sure i wear either a loud shirt or a pushup bra. sheesh...

food of the day (dinner at la rueda, 66-68 clapham high street, clapham, london):

mixed tapas, including pork fillets, garlic mushrooms, chorizo in wine, arroz y pollo...

listened to:

"fit but you know it", the streets

posted by Chas at 05:03
go ahead, roll the donut!

 
so this is it, final shift ever on the unit almost over... end of an era. *sniff*

came on shift tonight and as i had expected, balloon pump lady had died. as with most of these cardiology admissions to the unit, they come with blocked arteries with a decision made already by both the physicians and surgeons to leave them blocked, no further intervention being feasible. this lady was no different.

as luck would have it, around midnight, i get a call from the duty cardiology registrar with (surprise surprise) another request for a bed. two beds in fact. another two elderly ladies with unstable myocardial infarcts, both needing ballooning! one was already next door on ccu*, the other en route from a neighbouring dgh* (which usually cannot handle intraaortic balloon pumps on their own coronary units, hence have to transfer out). will this never end?!

so i go next door to take a look... the lady there does indeed need to come over imho, so we got on with that pretty smartish. very large anterior stemi* with pressures dropping to 50. took a while to get an art line in, all her peripheral pulses were thready and i didnt want to take up a femoral in case she needed to go for angio and/or ballooning. finally stuck in a left femoral. took her to cath lab for cardiac reg to site the balloon... was complicated by cannulation of the femoral vein, with subsequent tickling of the ra*/tv* prob, which triggered off a junctional brady and then pea*. got her back with minimal compressions and atropine/adrenaline. just as well we had venous access, as a temporary pacer could rapidly be put in! rhythm stable, balloon finally was placed. started inotropic support and watched her for the rest of the night...

the other lady arrived around 0200, but the cardiac reg managed to avoid a balloon and hold her next door, without needing to come to us overnight. had to step one patient down to the regular ward in the middle of the night to make way for this second admission. kept the bed open for her anyhow, just in case. *phew*

man, whats with all these cardiology admissions! =/

so made it to morning without much hassle, two postops doing ok. what a way to finish this job on, a full workup on one final real sickie, assessed, lined, ballooned and treated in the middle of the night. woohoo! what a way to go! wouldnt have had it any other way i guess. will miss this unit. good bunch of staff, great (for great read spanking brand new state of the art) unit, supportive medical team, one of the best jobs ive worked to date...

start anaesthetics monday. *shudder*

food of the night:

pork dumplings, tea

news:

- so sasser.d has struck the uk coastguard, hospitals in hongkong, the post office in taiwan and banks & railway network in australia since yesterday. only a level 2 threat actually. the earlier sasser.b was far more sinister, at level 4.
- "no stone will be left unturned" from the armed forces minister, on the inquiry into those daily mirror photos of uk soldiers abusing iraqi pows.
- the middle east roadmap has been discussed by the quartet yet again at the un in new york. doesnt look like much had been accomplished (again?). bush still backs sharons partial withdrawal plans, which had actually been rejected already by sharons own likud party. as with all of these things, this will never get anywhere. hmm...

----
* ccu = coronary care unit, dgh = district general hospital, stemi = st elevation myocardial infarction, ra = right atrium, tv = tricuspid valve, pea = pulseless electrical activity
posted by Chas at 07:33
go ahead, roll the donut!

 
well, penultimate shift on the unit over... strange kinda night shift.

having got fri/sat/sun nights in this run covered by seema and mark, i just have to work my last two shifts ever, mon/tue nights, and then im done.

an elderly indian lady with three vessel disease and a very unstable inferior mi* kept me busy most of the night. 4 stents had been stuck in her rca*, lad* left with diffuse disease, balloon pump going, haemofilter going, fairly low doses of noradrenaline and milrinone by all accounts, keeping a poor right ventricle alive with high filling pressures, cpap* on and an order for no surgical and no further medical intervention.

got handed over a lactate for her of around 3 with stable ventilation at the start of shift. however, lactate gradually crept up overnight to almost 5, no new changes on her 12 lead, no further chest pain. i was convinced her right ventricle was either becoming more ischaemic or had packed up altogether...

cranked up her inotropes, more filling, tried to float a swan. couldnt get into the ventricle, just couldnt. frustrating. abandoned eventually and tried the oesophageal doppler instead. still couldnt pick up any decent flow. meanwhile, her ventilation had deteriorated rapidly, partly cuz i had her lying flat for a while. had to intubate. things not good and getting worse. oh dear...

cardiology arrived by the end of the night. turns out her right ventricle is now akinetic on echo. no wonder i couldnt float the swan, there was no forward flow!

dont hold out much hope for her in this state. guess ill find out when i return for my final night shift of this job. =(

food of the night:

didnt have time to eat anything. bugger.

news:

didnt get a chance to catch up on any world news either this shift.

----
* mi = myocardial infarction, rca = right coronary artery, lad = left anterior descending artery, cpap = continuous positive airways pressure

posted by Chas at 13:00
go ahead, roll the donut!

 
may day bank holiday weekend is upon us again. was miserable this morning, but still went ahead with a day trip to the isle of wight with one of my bros and my parents. not had a family outing like this for ages. has also been around 20 years since we went to the isle of wight last!

lymington to yarmouth on a wightlink ferry, then to alum bay and the needles, the sequence of chalk stacks that stretch out into the sea from the westernmost point on the isle. there used to be another needle called "lots wife" (dunno why) that collapsed into the sea during a storm in 1764. right on the end of the needles stands the lighthouse, now automated since 1994. back on the needles headland, there is now an entertainment complex called "the needles park", with its famous chairlift down to the beach. amazingly enough, the cloud lifts and the sun now gloriously shines...

also on the headland is a monument to marconi and his world first wireless transmission station (1897-1900), from where he sent telegraph messages to ships out at sea. the whole site has now long since gone.

a further trek down to the calm fine sand beaches around brook in the southwest of the isle and it was time to head back to yarmouth. dinner at the celebrated saltys, a bar/restaurant in the town centre. some dude with a puter and a guitar provided live music. wasnt bad actually, as 70s rockers go.

ferry back to lymington and three hours later we were back in london.

food of the day (dinner at saltys, quay st, yarmouth, isle of wight):

cracked crab, half lobster, in shell prawns, deep fried whitebait with tartare sauce, moules marinieres, chips, salad, bread basket

wightlink isle of wight ferries
the needles park
the isle of wight improving island life

posted by Chas at 01:13
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man that was good. less people than last time, but still managed to get a good turnout for karaoke. jackie again gave me the usual bunch of discounts at the restaurant. adrian impressed with a song that he had previously learnt... in mandarin! not bad for an aussie! finished with a group choral rendition of a totally adulterated "killing me softly" (one time, one time...). almost as bad as the bunch of completely wasted dutch banker boys in the next door room and their attempt at "the banana boat song"... and as for their version of "im gonna be (500 miles)"... priceless! =D

headed to oneills across the street after restaurant kicking out time... had arranged a deal beforehand with the manager there too. i could get my bunch of trashed hospital staff in free and without having to wait in line around the block. the look on the faces of those kids in the queue as we strolled in... carol was well impressed.

denise was very umm... understandably happy shall we say. im just glad i didnt have to help her home! after all, this was partly her leaving party. even claimed never to have got my txt from earlier in the week. hmm...

food of the day:

- mixed starter selection of sesame prawn toast, crispy seaweed with grated scallop, vegetable spring rolls, chicken satay
- crispy aromatic duck
- shredded chilli beef
- spicy salt & pepper pork
- chicken with cashew nuts
- stirfried chinese broccoli with garlic
- stirfried beancurd, choisum and chinese mushrooms
- fried noodles with beansprouts
- egg fried rice & plain boiled rice
- fresh fruit platter

listened to:

"overdrive", katy rose. uk release 10/5/04.

interesting q of the day:

so how does one tell if real or if a pushup bra? =|

posted by Chas at 05:44
go ahead, roll the donut!