Seasonal Affective Disorder – You know it's getting bad when you look at the blank, white page of your blogging software and your mind just shuts down.
So lets tell you about the future of the NHS, and how it's going to drive me crazy.
On my patch we have a hospital. This hospital has two buildings, one is the traditional hospital that all UK residents know and love, corridors, wards, doctors, porters, nurses, radiologists and others walking around. Slightly grubby, dodgy café, doctors running clinics.
The other building, 400 yards down the road is shiny and new. It is 'nurse led', there are posh coffee bars, the floors and walls are clean. Not much in the way of wards, but this building is only supposed to be used for day-case surgery. Nurses run the clinics and there is a sculpture outside. This is the future of the NHS, a pre-polyclinic polyclinic.
Which is why I'm surprised to find myself responding to a standard 'chest pain' inside this building.
The patient is there to see one of the nurse clinics, she develops a bit of chest pain and the first thing that the nurse in charge does is dial 999 for an ambulance.
I get there second as one of our FRUs was parked within sight of it. As I enter the room, not only have they moved the patient (resulting in us having to do a bit of searching) but there is a bit of a flap going on.
You se, a doctor has been called and he is panicking. He's shouting orders to the FRU, orders which could be extremely dangerous (for the medics in the audience he wants us to give GTN/NTG before checking a blood pressure). Our patient is sitting quite happily in her wheelchair watching our FRU take quiet control of the situation.
This is an absolute 'meat and potatoes' call for us, we deal with this sort of thing day in and day out – just by observing the patient and listening to her we suspect that it isn't her heart that is causing the pain.
But the doctor is screaming about getting 'crash carts' into the room and the nurses are running backwards and forwards like headless chickens. A manager from the other site arrives looking flustered – they confide in me that they turned up because they were worried about what these staff 'were up to'.
After a little more kerfuffle we wheel the patient down to the ambulance, do an ECG (which is normal) and transport her the very short distance to the A&E department where, after some more ECGs and blood tests, is diagnosed with indigestion.
I'm reminded of my nursing days when I saw a GP doing the world's worst CPR on a woman who had pretended to faint – I would have thought her trying to fight him off may have given him a clue that it wasn't a cardiac arrest.
This isn't a post about daft doctors and silly nurses though, after all if I were called upon to anaesthetise someone I'd certainly make a pig's ear of it. We do have our own area of expertise and I can't expect everyone to be as expert in the emergency treatment of chest pain as myself.
This was a 'nothing' call, even without the benefit of hindsight – but as it was seen as an 'emergency', the best thing that the staff could think of was to call and ambulance and then a 'crash doctor' (and heaven alone knows why he was the only one to turn up, perhaps that's all they have staffing the crash team).
This points to there being a distinct lack of planning around what happens when something unusual happens, I'd dread to think what would happen if the patient had suffered a full cardiac arrest – they would have been little better off than collapsing in the street.
So, this is the future – you go to the nice, clean, artistically designed hospital for a minor treatment – but if you have a serious complication or something untoward happens the first thing they'll do is call for two blokes in a clapped out van.
Maybe it's just cheaper to 'outsource' emergency care to the ambulance service, maybe the next big thing for the NHS will be ambulances being called to deal with in-hospital cardiac arrests because then you won't need to pay for a full 'Crash team'.
I'm hopeful that somewhere in the planning for this 'healthcare centre' a manager getting paid a serious multiple of my pay-packet didn't think, 'well, if there is an emergency we can save money by just calling for an ambulance'.
Almost completely unrelated – my mum went to her hospital a few days ago and was told by a doctor that she should 'drink lots of water so that she doesn't catch diabetes', at which point she walked out in disgust. The same doctor recommended physiotherapy for something that would only be made worse by it. So its not just me that sees this sort of thing.
Even more unrelated – does anyone know a good (or want to set up a) heavy RP guild on Warhammer:Age of Reckoning Ellyrion EU server? Edited to say *Obviously* for the side of Order…