Karey and I wrote this after sharing a registrar post on the acute inpatient ward in Wellington Hospital. There had been some scepticism as to our ability to do this effectively. We took half a day each. Karey expressed milk for our firstborn. In the middle of the day we handed our son in one direction and a list of patients and jobs in the other. “He has had x to eat and slept for about an hour at eleven” in exchange for “Mr Y is newly admitted with depression and hallucinations, so-and-so needs bloods…” Etc. It worked. Not just from our perspective, but according to the team as well – at least that is what they said. There was one key person whose perspective we never obtained until it had faded from his memory…..
This piece was written during House Jobs. I had been on call for three days with almost no sleep. I still remember my tears when, as I dared to sink onto the bed on the third night, my bleep sounded. I sedated an elderly confused woman instead of finding out the cause of her confusion and helping her. I still feel shame, though do not blame myself. I suppose that I would call this self-compassion now. I was shocked at how easy it is, with sleep deprivation, to alter someone’s priorities.
West A. (1986) Personal View. British Medical Journal 293, 754.
Scroll down through the Twitter and Facebook flags to the bottom for posts and space to submit your own comments. Please remember to keep it friendly, though I welcome constructive and engaged criticism.
Then give me time to moderate the your post. I am not a blogaholic (yet).
This piece, described by one of my tutors when he saw it as a cris de coeur, was a frustrated response to the fact that a) I saw an attitude developing around me at clinical school that we should not question what was happening until we had more “authority” and, b) that there was a very poor response to questionnaires we sent out to fellow students and an even worse response to invitations to attend meetings to discuss the medical school curriculum. I was already pleading the authority of the subjective.
A good friend decided to drop out of medical school. Even that vocabulary is suspect! He decided to do something else. Maybe he floated out of med school, or jumped, cruised, wandered, ran. I can’t remember now whether his leaving was audibly commented on along the lines of “dropped” or with visible smugness on the part of those left behind, but I felt at the time that the med school – teachers, students and all – should have responded with greater self-doubt: could we have done better and might we have retained him for medicine? Medicine is such a broad school. With the danger of a narrow ethos. I am in little doubt that he would have found a niche and the profession would have been better with him in than out.
This paper was written while I was on my gap year in France. I think I had started it before setting out, but I remember editorial correspondence arriving in Caen, Normandy where I was working as an assistant de langue at L’institution Saint Joseph. The point of the paper is to suggest that the special piquancy of the minor triad is due to the interference frequencies of the tonic and minor third which, unlike those of the major third, are in remote dissonance with the other notes of the triad. The argument was based on pure tones in the untempered scale (sinusoidal waves without overtones) and I side-stepped the problem of how the effect of the minor third could come through music played in a tempered scale. I can’t answer this question now – perhaps the ear adjusts back to pure intervals. The Strad is still published. Has been for 125 yrs, now.