Iphone 5 is Shit

So, it's that time of the year when I go and upgrade my phone.  I've been using a HTC desire for the last couple of years and have absolutely LOVED it!  Before HTC I used to use a Nokia - which was the worst phone I've ever had.

Fact is I loved Android - I love how you have complete control and get whatever apps you want and put them where you want and you get widgets too!! With widgets you can basically get more information quicker.  So for example if you keep a news widget it'll be on one of the home screen and will automatically update the headlines and stuff.  It's really handy and gives your phone a real personal touch.  No two phones are the same with android.

But for some stupid reason I ended up deciding to get an iphone 5, mainly because I hate how large HTC and Samsung phones are nowadays.  My pockets simply can't fit a 5 inch screened phone and I feel like an idiot using them aswell. 

So I got my iphone 5 and was shocked at how shit it is.  I've never owned an iphone in the past, but I know lots of people who have iphones and have played with them in the past.  The first thing that hits you is that Apple basically just want to gather information about you and sell you crap.  It wants to know where you are all the time and it's the first thing it asks when you turn the phone on.  Then when you do finally go to the home screen it has all these ridiculous apps that you can't even get rid of!!  Why the fuck would I want to look at the FTSE??  I'm not into business, I'm a fucking doctor!!  Also, how BORING is the actual phone itself?? Is it me or is the iphone 5 just basically the same as the first iphone except with a higher spec??  I mean it looks the SAME!! It looks boring!! No live backgrounds which my old phone has, you can't place apps where you want, no widgets to speak of!! It's so boring!! I'm just looking at a static boring bullshit screen!!!

FUCK!!!

I actually tried to go back and return the iphone today, but they wouldn't take it back because it's not faulty.  I guess I'll just sell it to a douche who thinks this pile of trash is cool and get an Android phone. 

Iphones are shit.

Cannulation Tips and Tricks

The thing above is a cannula, which is used to give IV fluids and medications.  As a Junior Doctor, often my sole purpose as a human being is to put this bastard thing in some drug users shit veins or an obese idiot with an ultra low pain threshold.  Now, luckily I'm pretty good at getting these things in and I'm usually the go to guy if someone else can't get one of these in.  Here are the order of events and some tips and tricks I've come up with which never let me down!

1) Primary survery: 

Have a GOOD look on both arms of the patient.  Sometimes you'll miss an easy massive vein just because you haven't taken the time to look around and palpate both arms.  Don't be a lazy douche - put on the tourniquet in several different places and feel and look!  The other day I had to put a cannula in a Hep C positive drug user.  No one had been able to put a cannula in all day for his medications so it got handed over to me (I was the house officer on nights).  He had shit veins everywhere but he had a bulging vein on his bicep - which I got straight away.  So always LOOK!!!!!!

2) Put tourniquet on:

Yep even this is possible to fuck up.  Always put the tourniquet on ULTRA tight.  Look, even if you've put it on as tight as you can it's not going to harm the patient.  It's not going to cause myonecrosis in the five minutes it takes you to have a look and put in a cannula.  So put it on TIGHT!!!! REALLY TIGHT!!! And don't place the tourniquet too proximally.  It should be a few inches above the cannula insertion site.

3) Clean the area with a swipe (let it dry).

Yeah, most people can manage this bit.  Often cleaning the skin makes the area shiner and often pronounces the appearance of the vein.  Also, rubbing the vein makes them stand out due to mast cells releasing histamine and the endothelium releasing crap like leukotrienes.  Also don't be afraid to really tap the vein hard before putting in a cannula.  It really works and you get to hit patients.  I mean really tap them hard.  I don't care what others say - it makes a massive difference and it's less painful than repeated failed attempts.

4) Put in cannula 

Ok, this is the make or break time.  ALWAYS make sure the vein is REALLY taught when going into a vein.  Do this by anchoring the vein distally to the entry site.  I'm right handed so I pull the skin taught with my left hand.  I make sure my left hand isn't too proximal to the entry site so that it's in the way (which would mean that I'd have to go into the vein at too much of an acute angle with the cannula), or too distal (which would mean I'm not able to pull the skin taught enough).

Always enter the vein at a NARROW angle!! As narrow as you go!!  People often go in at too much of an acute angle = fail already.


5) Get flashback 

Some people say go in a couple of mm because if you have flashback then the tip of the needle is in but not necessarily the catheter itself.  The fact of the matter is that this isn't always true.  I VERY rarely advance the needle any further once I get flashback.  Instead I hold the needle very very still in place and push in the plastic catheter - the needle simply guides in the cannula.  This is make or break time and loads of people fuck up here.  If you follow my advice then it should be ok.

6) Retract needle and get second flash back within the plastic catheter and advance catheter in vein 

You have to do all of this with ONE hand.  Your non dominant hand should always be keeping the skin taught.  Until you can insert the cannula and pull of the needle with one hand you'll never get good at them and will continue to mess things up.

7) Remove tourniquet, flush with normal saline, put on tegaderm sticker

Tegaderms are shit.  I always mummify my inserted cannulas with tape to make sure they don't move and that nurses don't pull them out by accident. Also alot of patients are stupid and will pull them out accidently when they go to wipe their ass or something.

EXTRA TIPS!  Finding a suitable vein is often the hardest part - esepecially in long term patients who have been stabbed constantly for the previous three years or whatever.  When finding a vein always pull the skin taught to see if the veins are malleable and able to straighten up.  Often a vein will seem like it's too short or has too many angles, but they can be straightened up.

Also, remember that if you can see it you can get a cannula in.  Often in fat people you can't feel a vein but you can see them.  There's no reason you can't get a cannula in.

Veins which are literally a green tiny thin veins - you can get blues into them.  Anything bigger is a pink at least.

Don't be afraid to go in the anterior surface of patients forearms. For some reason people tend to overlook them, but a lot of the time there are some awesome veins there.  On the anterior surface of the wrist is also often a gold mine.  It's quite sensitive and painful for the patient but there are good veins there!!

Anyways I hope this has helped someone.  This is all the shit I wish someone had told me before I started work as a ward monkey.

Is it possible to NOT be a dick??!!

Man, the senior doctors are dicks!! 

Let me explain - hospitals are built on hierarchy.  This is probably because doctors have spent most of their lives in education being told off by idiot professors who get angry that you don't know the submicrohistochemical process which make your nipples hard sometimes.  Doctors build up this rage,  which festers away until one day they unleash their fury on their ignorant subordinates.  And so the cycle continues.

The more senior a doctor gets, the more they think that no one else/no one elses opinion matter and that what everyone else does has absolutely no value.  This is STUPID!!  I mean, let's face it, if we didn't have.....say cleaners, the hospital would fall apart, without nurses there would be no one by the patients side for twenty three hours a day etc etc.  Everyone plays a role and everyone should be appreciated.

The modern hospital system is a joke.  I'm not a fucking kid that I such continually be made to feel like shit because I don't know something which my seniors know and I don't.  The only difference between a junior doc and a senior doc is experience.  That's it.  And above all why should ANYONE be made to feel like shit at work?  Nurses get continually berated by doctors and porters and cleaners are made to believe they don't even exist.  It's bullshit. 

I really would've thought that people interested in helping and caring for their fellow man would work in a system which is inherently caring - not inherently mean and with a morbid preoccupation of disciplinary action.

Reality Sucks

God, I loved medicine. 

I remember reading all those stupidly big textbooks in med school to become a well rounded doc.  I remember all those sleepless nights spent memorising bullshit that makes no logical sense, the oh so boring ward rounds that I had to attend to get a piece of paper signed off and all those BORING lectures which were designed just to piss me off.

But you know what, I MISS my medical text books.  When I didn't have the pressure of an indoctrinating, conforming exams over my awesome head, I actually loved reading my books.

The world of medicine in my books is perfect.  The way everything is presented is perfect.  First comes the introduction, then epidemiology, then aetiology of diseases, then physiology and pathophysiology, then clinical signs and symptoms, then treatment and then finally prognosis.  Aaaahhh perfection!!  Devoting your life to learning about the human condition really is quite interesting.

Too bad being a doctor SUCKS!!!  It's nothing like my books!!  Where in my books does it say that I'd be spending most of my days ringing up different idiots to do stupid things??!  Spending three hours on the phone to a hospital only fifty miles away to get a patient transferred is NOT medicine.  Neither is ordering blood tests and writing blood test results down for several hours a day.  I don't get to use any of that knowedge I've slowly accumulated!

It's really sad that I have to spend most of my days doing stupid secretarial jobs instead of actually treating patients and spending time with them.  The most worrying thing is that I honestly think I'm in the minority who sees how ridiculous being a doctor is nowadays and that most people just accept the situation and don't want things to change or fight for things to get better.  Sigh......I hope one day doctors can just do the doctoring.