Good , bad, is, was.

Latest report from worm in horseradish

4 statements

• The first of the Chilean miners were released overnight....great
• Clare Rayner ('I like stories, the stories of other people's lives') dies...not so great, RIP
• 'To a worm in horseradish, the world is horseradish'...jiz (just is)
• If monetarism and the Falklands dominated Thatcher's first term, the second term was dominated by the miners' strike...Marr's History of Modern Britain...

Just started a new job so short of unified prose this morning, concentrating in the job at hand (in horseradish).

Having said that, focused on my patients, particularly my older ones... systematic review of interventions in emergency care to improve the experience of the older person (Clare Rayner might have been interested in this) underway, steeped in British history because periodically listening to a track on Andrew Marr's reading of his own book...out a while ago
 

And the first of the miners is released. They truly have been stuck in horseradish, though, by all accounts, they have managed themselves and been managed (by, amongst others, experts on submarine warfare) well throughout. Their story does not stop here though (and fingers crossed for the rest of the rescue).

Keeping up appearances

Keeping up appearances, looking the part and the doctor's white coat:

How much does what we wear matter, whether at the bedside, in the interview, at the audition, in the street or at the party? I remain interested in this. It clearly does matter, but the answer to what to wear, and when, is clearly for an individual to make their own mind up on.

Male friends

I went swimming with a male friend yesterday...in North Yorkshire.

 

We swam a few lengths; a bit of crawling, a bit of breast stroke and, even, a bit of back stroke.

 

We celebrated our swim with a two length race.

 

It was a very close finish. During the shower afterwards we chatted away.

 

Then we popped into a connoisseur's ale pub in Knaresborough, had a tomato juice and a bite (or nibble) to eat, (a pate and bread platter), more chat about this and that (cookery courses, smart phone apps, patients who fall and call an ambulance, living as if death is not too far away at any time) before going our separate ways.

 

I planning an early night and an early start tomorrow (lots to do before the weekend), he planning an early night and an early start (an early shift).

OK, so why document my evening?

Two male relationships in the news yesterday, the day the US celebrate the end of combat in Iraq; William Hague and his 25 year old political advisor and Gordon Brown and his 25 year political collaborator. Nothing much to say about them, other than it got me thinking about male friendship, or lack of it.

As for our race; he thinks he won, and I think I won...a fair result.

Timing as tool

There is that old gag 'Ask me what the most important element in comedy is'. 'Ok, what is the most important...' 'Timing'.

 

Doesn't translate well to the written page but I was reminded of it the other day when I was participating in a cricket match at the local cricket club, whose ground was once graced by the sound of leather on Len Hutton's willow...

I say participating because my contribution was four fold

1. well in advance of the coin tossing to eat a wonderful bacon sandwich prepared by the club caterers for us, while reading a the article in the Sunday observer about events in Northern Ireland
2. five minutes before the match to be called into work - I was on call
3. to return as our team  (well, one of our team members , called Stick) hit a fine off drive to win the game so that I was able
4. to tuck into a terrific barbequed beefburger and sausage prepared by the wonderful caterers and 
5. finally to receive a fine (half a coke to be downed or poured on one's head to the harmony of 22 mixed cricketers all wearing red dresses) for reading the paper before the match. (I'd have thought missing the whole match, and not getting a bat while wearing a red sarong, was a far worse crime).

Five fold I mean:

 

Now, I was reminded of timing, not because of my uncanny ability to miss the whole game but because, of course, the thing that really sets the great batsmen out from the less great, if there had to be one thing would be timing...and balance...and hand eye co-ordination...and a firm top hand...and the 10,000 hours spent in the nets while still wearing shorts and a cap

I was a much better tennis player than cricketer, and timing is important in tennis too .

And timing is important in emergency departments...national standards include:

• Having an ECG within 10 minutes if you are having a heart attack...which really means if you having symptoms which MIGHT be a heart attack.
• Getting pain relief within 20 minutes if you are in severe pain (which can mean if you say you are in severe pain, but this does involve judgement on everybody's parts).

I could go on, but it isn't the purpose of this blog post to list the national standards aspired to by emergency departments, more to move timing on from comedy, to sport, to work and on and on.

Hashers call 'on on' when they reach an onward indicator on the floor (or on the top of a gate post or on top of a cow pat...).

 

I deliberately chose to blog about time now, because I thought it would be a short topic, short in duration rather than height. It is timely that I stop because time is short.

On on.

Invisibility as superpower

Here we go on invisibility: In the car on the way to the hash ( great running goup I have joined), on Tuesday this week, a fellow passenger said that he had been listening to some podcasts as a means of keeping in touch with the USA. (He is from the USA). The podcast described an American who, as a conversation starter (or ice breaker or whatever), was asking people what superpower they would chose to have if offered a choice. Among the answers people gave were 'Flying' and 'Invisibility'. We discussed the people who are flying in suits with webbing like the man from Atlantis (who was in Dallas but reminds me of the man who played the Incredible Hulk first time round,with the sad piano piece at the end...'you won't like it when I am angry'.

It just so happens... no I don't have this power...that I have thought about it before:

If one leaves aside the obvious abuses one might make of it and the idea that observing anyone without their knowledge is potentially breaking their right to privacy.

 

Though I'm sure we all do it all the time, probably not with malicious intent, what beneficial use of it might one make?

• The fight against crime; policing and justice
• Fighting of the worthy war
• Sport (rugby, there would be no need to feign injury but how to carry the ball when invisible?)

In addition to thinking about this... the idea of being permanently watched, perhaps by CCTV.

Even the afternoon murder series with the upright American lady...whose name I can't remember but I keep expecting Dick Van Dyke to appear in the same programme... had a take on this one in a recent episode.

 

An innocent man cheekily piggybacks onto a neighbour's cable connection and gains his girlfriend access to what he thought was a TV station but turned out to be the a secretly placed CCTV camera in a neighbour's kitchen...

 

...and before they realise it is fiction, they watch a group of men conspiring to commit a crime.

 

Eventually there is a shooting in the flat, a woman goes missing, they start seeing the 'actors' from the film in their street...then the penny drops.

Invisibilty as topic for a serious film

 

As a screen play?

• Setting and Context (who, when, where): an individual in the UK in modern times I presume. Elementary
• Discovery of superpower
• Control of superpower.
• Deliberate action (telephone box like wonderwoman?)
• Consumption of something (magic potion)
• Response to emotion (Incredible hulk)
• Change of clothing (Batman)
• Plot;
• Goodies vs baddies
• Moral choice,
• Topical dilemmas....personalisation/internet and the world wide web/closed communities of applications
• Humour, without killing it off (like that scene where Legolas surfs down the steps on his shield)
• Music/soundtrack
• The contrast with being permanently watched

I suppose one place to start, as did the Sherlock Holmes guys, is with the original and subsequent interpretations. Was it H G wells? I shall have do do a bit or research. MMMmm

Invisibility

I don't think invisibility has been dealt with in film with the 'seriousness' that it deserves.

 

If we can modernise Sherlock Holmes, what about trying to modernise invisibility?

 

You'll say what about the film with Kevin Bacon?

 

Kevin Bacon?

 

Fine. I just don't think the seriousness was there.

 

What do I mean by seriousness?

 

I do not mean the absence of laughs, nor necessarily massive cost. 

I mean that the idea is filled with such great potential for all we would want in a great, great (British even) film, isn't it?

 

Invisibility, the idea...

Conversation, why I go on about it

I go on about conversation.

 

Why?

I see it and hear it in action and occasionally participate in it myself.

 

I read conversations (albeit one way conversations).

 
Conversation created the renaissance, the enlightenment, modernism and post modernism. It can be compared to food:

• Rhetoric = rich food
• Scientific talk = health food
• Plain talk = fast food
• Political correctness = the diet
• Wit = haute cuisine
• The new conversation = the banquet

The conversation of love changes ourselves and the environment.

The family is the teacher of the art of conversation with strangers.

The challenge of conversation at work involves specialists in different fields talking to each other. This requires a common language.

The challenge of technology is to have the courage to make choices and to avoid naïve optimism and cynical pessimism.

Travel conversation allows ideas (including those of religion) to pause and make love.

Ref: Conversation, Theodore Zeldin

Queueing

I was at the front of the queue at a council owned swimming pool a while ago, waiting to be allowed to proceed to the changing rooms, with both my daughters, when the young attendant shouted imperiously at us (whilst seemingly looking in my eye) to move back. I had to make a rapid decision; did I...

• Turn around and push the poeple behind us over and like dominos knock the whole queue over?
• Shout imperiously at the people behind me to move back...craftily passing the buck on to them?
• Whisper to the people behind me to 'move pack, pass it on' and see if the message got to the back of the queue before the young attendant lost his rag and thumped me (and if the message did get to the back of the queue, see what it consisted of by then)
• Like a shrinking violet, step out and walk towards the back of the queue, with my eager young girls dying to get into the swimming pool beside me, and risk them thumping me, and losing our place in the queue, perhaps forever?
• Shout back at the attendant, imperiously, what the hell did he think he was playing at shouting at the people at the front of the queue to move backwards?
• Just stand there and feign ignorance, perhaps pretending to not understand what he meant?
• Have a quiet word with the attendant and suggest he manage his queuers a little more sensitively?

I've been more interested in queues since. For example, the idea that better to have two queues, one for the shorties and one for the longies (by which I mean the time required to deal with their problem or their shopping basket) as practised by most supermarkets and some emergency departments.

 

The experience is, and I'm led to believe that the evidence suggests, that by having separate queues, seeing the quickies separately from the longies, you reduce the overall length of stay, and therefore the numbers of people in the shop/department (for some time after you revert back to one queue) and increase their satisfaction with the service.

Another related idea from the emergency department is that if decision making is likely to depend on blood tests being done, get these tests done on arrival in the department, rather than waiting for the decision maker to see the patient and then take the blood (practiced widely by 2020)

 

Does this translate to supermarkets?

 

Only if you engineer the blood testing to be like the summing of the cost of the goods bought, hence the introduction of personal barcode scanners, so you scan your goods in as you go round the shop taking them off the shelves.

 

Better still if you pre-order your goods over the telephone or on line.

 

Some people do ring up the emergency department and ask how busy it is at that time or whether they are planning to come to the right place.

I shouted back at the young attendant of course and immediately realised that I hadn't use what emotional intelligence I have and might have been better having a quiet word with him about how to move a queue backwards, perhaps by going to the back of the queue and leading them backwards first and then proceed forwards along the queue.

 

Try queuing theory.

Chorizo and scambled egg

The other night at an award winning tapas bar in a certain Yorkshire town I was served a tapa of Chorizo and scambled egg.

 

As a combo, I'm not so sure.

 

What I was more irritated by, well not irritated, but thought comment-worthy, seeing as I was one of about three people in the place, was that my feedback was met with a stony silence.

 

I didn't expect a free glass of sherry, but.... go feedback!

 

The scrambled egg needed much more seasoning!

 

Got to be prepared to receive it too.

Granny air bag

Granny air bag

The most amazing footage of a great, great moment, whether real or not.

Inception

Dream within a dream within a dream:

 

Liked the idea of creating a dream maze, the idea of ones subconscious taking the form of people who then attack any intruders and the idea of the impossibility of knowing whether we are dreaming or not. 

 

Great dreamscape reminiscent of Where Eagles Dare.

 

What else? Thought insertion and withdrawal...one could go on and on.......and on

Looking the part

Never been into wearing suits. They say that it neutralises one, that it stops people thinking about your clothes rather than what you say; the words, the song, the dance? Not sure about this.

I do accept that keeping up appearances is appropriate...sometimes. The mental state examination includes making a note of a patient's appearance.

Equally looking good can make you feel better. But you can look and feel good in a pair of jeans, can't you?

Nine key steps to understanding the internet

Taken from John Naughton, the Observer, News Review 20.06.10, a framework for seeing the phenomenon 'in the round'

1. Take the long view; it's too early to say what's going on
2. The web isn't the net; web pages are only one of many kinds of traffic
3. Disruption is a feature, not a bug; intentional facility i.e. deliberate
4. Think ecology, not economics; dinosaurs trudge (eg Encyclopaedia Britannica) alongside giant new life forms (Google, Facebook). "Increased bio-diversity closely correlated with higher whole-system complexity"
5. Complexity is the New Reality; intelligence, agility, responsiveness, and a willingness to experiment (and fail) provide better strategies to deal with the emerging environment
6. The network is now the computer; the transition to the cloud has profound implications, including greater dependency. We're sleepwalking into this brave new world.
7. The web is changing; no longer just a publication medium (web 1.0). Web 2.0  "small pieces, loosely joined. Web 3.0 "semantic web", global, self organising...
8. Huxley and Orwell are the bookends of our future; insights that we will be destroyed by the things we fear (Huxley) and love (Orwell)
9. Our intellectual property regime is no longer fit for purpose

Influencing others and changing people

It's not my intention to make this a self improvement/advice offering blog but..... let me suggest this to you...

 (reminds of that Peter Cook sketch where he plays McMillan and says "I received a letter, the contents of which are indellibly imprinted on my mind, let me read it to you")

.....when trying to influence oneself and others, there are ways of doing it;

• Evidence (philosophy and history)
• Money (economics)
• Force (Politics)
• CBT (psychology)
• Separation (geography)
• Conversation and love (?sociology)

For examples,

• If you do it like this, you'll achieve what you are trying to.
• Do it and I'll give you a fiver/you'll get rich.
• Do it or else.
• Do this and it 'll make you feel like you're getting what you want.
• Go away so I can get on with it.
• Come on, lets do it together. We'll get it done quicker, we'll both learn from it and perhaps we'll even enjoy doing it. We might even want to do it again.

How to converse

I'm not interested in learning how to chat someone up, but when you put 'conversation' into Google, you come up with some funny stuff. Either click on the links or do the search yourself

Have a great conversation
Come-Up-with-Good-Conversation-Topics
About Dating
how-to-be-a-brilliant-conversationalist

Structuring a post, a template if you like

One could use this structure:

1. Context, goals
   
2. Current processes
3. Outcomes

One could just write what one thinks and feels one wants to write.

Groups and cults

I've just set up a couple of Google groups, one to discuss Conversation itself and the other for people interested in EDCOE, Emergency Department Care of the Elderly.

For now they are invitation only, though my intention is to open them up if there seems to be an appetite.

If strangers follow for my tweets, they might want to participate in these group.

Back in the Saddle

December 2010.

Now, where was I?

Oh yes: Currently thinking about 'Conversation' and Care of the Elderly in the Emergency Department.

Conversation just is; can be good, can be bad...

Emergency Department Care of the Elderly: Study it, think about it all the time, and, converse about it.