Fourteen-twenty

When a pair comes together there's a lovely warm feeling they match! nothing better though at times it's tough and holes will appear you can never have enough that's why I'm telling the world I'm letting it out of the box; these are the things I love about socks.

This is a poem to all women well, not all women, for a start, I'm not sure that all women can read I concede that maybe I should have started smaller, 'a poem to all shrews', something like that then again, I'm not sure that many of them can read either neither do I have much to say about them.

I thought I'd do something nice today, and then I thought I’d write you a poem. 'Why not do both?' I thought after that. So I think I shall do that without knowing. Poems shouldn’t be difficult to write, but this one is. So I think I shall write disjointed clauses, And then to make it a poem I’ll simply cut the sentences with pauses. I don’t really see the point of this poem, I mean I wrote the end before I wrote the rest. So I suppose I started with just a few words; I love you, you're the best.

I don't think I know how to write a poem, because I never really paid attention when they taught us about rhyme but I suppose that’s not essential, because a poem is a feeling, I think that has been converted to words so that the feeling can be read over and the poem returns a touch of perception, a sense of cost, I mean of understanding, of comprehension that sadly would otherwise be lost.

For a school exercise we had to write a letter to Holden Caulfield , and imagine a response. Here is what I wrote. Dear FT, Thank you very much for saying that my book was that good. It makes me really proud to hear someone say that. Anyway so I should answer your questions. Yeah so I did go back to old Mr.Antolini’s house after all because I was really feeling sour leaving the old guy all of a sudden like that; but it sure was freaky him touching me like that. I thought that he was a goddam pervert or something! Anyway so I went down there and I asked him why he did that and he came up with all this bull about being lonely and all and he thought that I looked to peaceful when I was asleep. Sometimes that Mr.Antolini can be real neat, but sometimes he sure can be a real bore. I mean we’re all lonely for chrissake. I mean every now and then I feel lonely as hell all alone in my room. Sometimes I think back to old Jane, or Sally and what life would be like now if she had agreed to come t...

I ask most clinicians the same question. 'Tell me about the last patient who taught you something'.  RH smiles a wry smile. Man hands on experience to man. He draws up a patient's notes, and together we read through the letters. The story emerges of a otherwise healthy middle-aged man who is fitted with a pacemaker. Every year thereafter we find a letter that reads; Pacemaker checked - normal operation The list continues for several years without excitement. Suddenly there is an aberration; frank, in black and white;  Out of hours service. Your patient has died The next letter is the pathologist's report.  Cause of death: tuberculous myocarditis I suck my teeth. 'So what do you think is the lesson here?' he asks. Turning the question around; an old trick. I smile a wry smile. 'Always be on the lookout for tuberculous myocarditis.' He says no, firmly but politely. He is right. The lesson is finer than that. We can no more be on the lookout for tuberculous...

 Men who roll their own cigarettes (and they are invariably men) sometimes develop a curious automatism of the hands, whereby they continually mime the action of rolling the paper. This may at first glance mimic a 'pill-rolling' tremor.

 'Was she comfortable, doctor?' I looked into his eyes. It had been a prolonged cardiac arrest. My wrists ached. I could still feel the crack of her ribs. We had got her back twice and she had gagged on the tube, choking and vomiting, before we finally called it after an hour. I looked into her husband's eyes, and I lied to his face.  'Yes, she was comfortable. She was asleep the whole time.' I felt sick. That's one of a hundred memories I don't want. 

 It is a truth universally acknowledged, but not often stated, that clinical judgement is insufficient to exclude subarachnoid haemorrhage with acceptable certainty. Why wax lyrical about the minutiae of the clinical assessment? Perhaps the neck was slightly stiff. Perhaps one pupil was slightly sluggish. What of it? Ultimately, when the patient came in complaining of a first episode of acute severe headache, we all knew that a CT was inevitable. And, to boot, since we were sufficiently suspicious of subarachnoid haemorrhage to perform a CT, and in the absence of a compelling alternative explanation, we would be negligent not to then follow-up the normal scan with a lumbar puncture after 12 hours to look for xanthochromia.  Is this intellectual bankruptcy? Wise heads on the post-take ward round will cluck knowingly. 'Ah, rushed in with a scan, did we?' How infuriating! The luxury of the normal CT scan report is enabling of maddening arrogance. The same is true of troponin. A 6...