One more thing….

Posted on August 7, 2019. Filed under: Uncategorized |

Sometime I don’t sleep well. I lay in bed reflecting on the day I have had, and the things that add pressure and stress to it, and then something strange happens, and I start to make up rhymes, (they aren’t good enough to call poems), so here is the latest, composed at 2am.

One more thing….

Oh Max E Nurse, you have treated me great.

And I know I have already made you run late,

But just before I go,

I’d like to let you know….

About one other problem that I’ve got,

I don’t like to put you on the spot….

It’s for other’s “One problem per consultation”.

But that doesn’t apply to my constipation.

The patients in the waiting room don’t look so ill.

They’ll just need a prescription for a pill.

So I’m sure you’ve got time for my little worry.
You’ll soon catch up if you hurry.

It’s just….
A little chest pain.
Associated with some weight gain.
and when I sleep I snort,
I think it’s due to my nasal wart…

or maybe as my breast have started to sag.

Did I mention my rash?
It looks like the Russian flag.
My nose has started to drip.

Oh, and my achy hip!!

You thought I’d gone, well, nearly.

You didn’t want to go home really…

…before I got to tell you about….

When I had babies,

and they thought I had Rabies,

and my finger nails itch,

I think it’s cos my mum was a bitch,

That’s why my anxiety is high,

and I have an ache in my thigh.

I think it could be a DVT,

I saw a program on TV.

Why are you opening the door?

Have I told you before…

…about the time….

my skin turned the colour of a lime.

Those patient’s in the waiting room,

Will get to see you fairly soon,

They really do look rather cross.

Don’t worry, I’ll tell them you’re the boss.

and will sort ALL there problems too…..

….Did I mention the colour of my poo???

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Letters I would like to write – 1

Posted on November 16, 2018. Filed under: Uncategorized |

Ever have one of those nutty days when it is mad busy – someone has opened the flood gates to hell  – there are 10 people sat outside your door wanting to be seen when you arrive, glaring at you for turning up after them – even though your shift doesn’t start for another 40 minutes. Despite this you drop your coat and crack on ASAP to save the little old loves waiting for any longer than they have to.  Yeah I’m ready… Lets go….

Then someone comes through your door to address a concern that is already being addresses. They don’t care that you are really mad busy today, short staffed and trying to do the work of four people single-handedly… they have an agenda – they want you to write to a consultant to get there appointment expedited, and they are not keen to take “no” for an answer.  

Image result for images grumpy old man

Such a case inspired me to write the following – which at this point I have not yet sent to the consultant – but I might.

Dear Consultant,

The above patient attended my clinic today having been referred to your goodselves last month due to some mild symptoms that resolve with basic treatment, but return when he stops said treatment. He wishes for a cure and as such one of my colleagues referred him to you. I assume this was to get him out of the consulting room, as he was probably as stubborn about being referred as he was about me writing to you today.

It appears that he has been given an appointment next month and that despite being asymptomatic when he uses treatment  he feels he needs to be seen earlier so that he can get your opinion with regards to a cure.

I was wondering if you could boycott one of your extremely rare coffee breaks or move a seriously unwell patient to a later date, so this perfectly asymptomatic man can be seen.  Obviously if you don’t actually have a coffee break or if you do care enough to see the seriously ill patients as a priority, you may wish to write to the department of health to ask for extra doctors so this man can be seen or failing that write to a geneticist to enquire whether you can be cloned so that you and you can get through more patients.

I have advised the patient to continue using his treatment that makes him asymptomatic until such a time you can see him.

Yours Sincerely

Max E Nurse.

Letter not signed – but you can see the imprint of my forehead from where I banged it on the desk…Personally I was tempted to bang the patients head on the desk but felt this might be slightly frowned upon – pun subtle but intended!

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Guest blogger….pain in the Arse!

Posted on June 7, 2018. Filed under: Uncategorized |

Letter from a Fox….

So I am busy, and I don’t write much, but when I finally get around to posting something, I get a comment from Nurse Fox, saying I should write more often. I offer the gobby fox and opportunity to try her hand in my absence, and rather than being a fox she turned out to be a game bird…she writes:

I admit I am a late comer to this blog, but at present I am on a work conference ( primary health care – it was free so couldn’t pass up the opportunity) and stuck in one of those delightful cheap ( I got study leave but am paying for travel and hotel myself) hotel rooms that isn’t quite clean enough to walk around in bare feet. (Max: Like one of those patient houses where you wipe your feet on the way out!). I have a motorway and petrol station for my view and can hardly hear the radio above the noise. So I need to amuse myself and this blog is certainly doing that. It is also delaying my trip to the petrol station for ‘dinner’, which I am thinking may consist of some kind of pasty, a bag of crisps and a chocolate bar. Do you think lawyers and politicians have this kind of experience on business trips ?

Upon asking Mr Nurse if he would mind getting off his lazy arse and produce more frequent musings he invited me to ‘have a go’. This is where my problem starts, I’m rubbish at writing and my spelling and grammar would turn a primary school teacher (Max: and your editor….) to drink. But one of the many flaws in my personality is that I love a challenge , no matter how dangerous, impractical or just plain daft if may be – so far this includes;

Flying to Tanzania alone and getting stranded in 3 different countries before getting to start work on a medical boat treating conditions I had never seen before;
Climbing Mount Kinabalu ( highest mountain in SE Asia) alone;
Attempting to Climb Mount Kilimanjaro this September alone;
Joining a choir when I can’t sing;
Asking a GP for a job and to train me where no position existed;
Undertaking my Masters whilst working 2 jobs and doing diabetes and CVD modules ( plus 2 kids , 2 dogs and husband);
Popping out 2 sprogs without any analgesia;
Challenging the process used by the RCN to ban staff from their forums and getting the process changed. Yes it was me that got banned!
Always having something to say at CCG meetings, however unpopular that makes me.

Now some people may assume this makes me rather annoying, and they would be right. But a lot of this comes from the fact that I am passionate about being a nurse and doing what is right for my patient as well as myself.

So yeah I will give it a go, I have come across many issues that Max has previously blogged about, although I am nowhere near as bright or funny, (Max: Stop blowing smoke up my arse!).

I thought I might chat about something I have grown intimate with although I don’t actually have one. (Max: it sounds like you’ve got balls so it isn’t that…)

Picture the scene “bend your legs up further Mr Smith , if it hurts or you want me to stop please just say, don’t kick “ gloves and lube at the ready, I’m going in….. ….(Max: “…and if you are really enjoying it please don’t say!”)

So how did Mr Smith end up with his knees by his chin, clenching his sphincters as if his life depended on it . Luckily , even though he has his pants down in front of a (moderately) attractive nurse practitioner , he has no risk of getting an ill timed , inappropriate erection… he is just too bloody petrified.

He ended up here the same way most of his contemporaries will, his wife told him to go and get “things looked at.”

He has been experiencing lower urinary tract symptoms (LUTS) which he has gainfully been ignoring, but the wife is sick to death of being woken up several times a night. She is worried it might be cancer, and even he cannot fail to have noticed the recent prostate awareness campaign that is popping up through his regular sports viewing.

Luckily for him he has symptoms , that makes it extremely unlikely he has prostate cancer , and if the symptoms were caused by cancer it would be very advanced and he would be unlucky enough to not likely make it past a few years.

But lets get back to the cheerful side of prostates, incontinence and cancer.
LUTS are caused by Benign Prostate Hypertrophy (BPH) or in rare cases very advanced metastasised prostate cancer.

The recent prostate campaign has seen an influx of the ‘worried well’ or as Max likes to describe them the ‘acutely well ‘ for PSA tests and , and if you can convince them, a digital rectal exam…..(Max: I love the idea of it being called a digital rectal exam…and patients thinking it’s a new fandangled technology..like digital radio, and then getting a very low tech finger up the arse!)

As healthcare professionals we tend to scoff at the ‘well’ asking to have blood taken and a finger inserted up their bum. We listen to the ‘my wife sent me’ story and wonder if these men are hen pecked, and why couldn’t they decide to come themselves , but that’s a whole other story.
Statistics show that most prostate cancers do not produce any symptoms. So we are being advised , by the experts , that if a man has plucked up the courage to come in and see you and asks to be poked and prodded ( even if his wife has him in an arm lock) we should oblige.

Family history and race are better indicators than symptoms .
If you are a man over 50 ( nearly there Max) then you have a 1:8 chance of getting prostate cancer, if you also happen to Afro Caribbean that increases to 1:4. Not great stats for Mr Marley from Trinidad ! More men die of prostate cancer than breast cancer, but breast cancer has 10 times more funding. it appears breast is a ‘sexier ‘cancer that people are willing to throw money at.

Numbers needed to screen (NNS) are just 293 for prostate , yet 2000 for breast and 1200 for bowel cancer and that’s with screening programmes .
PSA (Max: Prostate (not very) Specific Antigen) , although not perfect, is one of the best tumour markers around. Just remind your men, no ejaculation (yes they usually roll their eyes as if to say ‘chance would be a fine thing’), vigorous exercise or prostate massages (for prostatitis or pleasure !) for 48 hrs before the test. (Max: definitely no masturbating while riding a bike then!)

It’s a no brainer, if a young (experts advise 40 years onward) man comes in with not a single symptom we should screen him, even if it goes against our gut instinct.

You can also lighten the mood at the end of the consultation by letting him know that if his screening came back suspicious, he no longer has to have a foot long needle stuck into his rectum, winding its way through his poo and into his prostate whilst awake. They like to use MRI now, with biopsies taken through the perineum using a ‘Battleship’ type grid and approach – “needle 1 to square B6″… so no chances of sinking any battleships, just straight into the old prostate.

Finishing on a cheerful statistic, the new robotic machines that undertake a significant amount of prostate removals only malfunction in 1:1000 cases.


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Am I getting old yet?

Posted on February 18, 2016. Filed under: Uncategorized |

Last week an 81 year old lady came to see me complaining of feeling a little tired and light headed about once a fortnight for a few minutes each time…. I tried to seriously address her concerns whilst wondering if at half her age there wasn’t something wrong with me… As I feel like this much more often!

Then later in the week an 83 year old came to see me and said “thanks old man” as he left!    Crap I am less than half their age!! What hope do I have!?!?

One of my other “little old ladies” is just back from another exotic holiday… Hot air ballooning over Kenya!

Mrs Smith – you’re supposed to be in the basket!!

It all seems grand… Until one of the benefit posse come to see me… Younger than me, but on crutches, under the pain clinic with no recognisable diagnoses but heaps of meds and enough benefits to afford a far nicer car than my humble nurse practitioner wages can afford!

I do worry about a bit of a organised crime link in some of our patient groups…. Now I’m by no means talking about the Mafia… I love the Mafia…. (Not really, but I don’t want to wake next to the head of an old nag….. (No jokes about being married!)).

We seem to have a group of benefit claiming families, with multiple health problems who all seem to be really good friends with each other… I’ll go into the waiting room and find several patients that sink my heart and are not related to each other… But only one has an appointment and whoever is being less disabled/demanding that week has driven the more poorly patient down to the surgery! Perhaps my organised crime theory is wrong and there is some kind of group of unlucky friends that are coincidentally all ill… Or perhaps a Facebook group called; The unfit and unwell of Sickton! A special group where these poor sickly individuals have all joined and that’s how they know each other….. If I was friends with them all I think I’d start being treated for paranoia symptoms…is there one fit one in the group slowly poisoning off all her friends – will I be next???…..   urrrrrrrrrrrrrrrrrrrrrg

Paranoia and conspiracy theories aside….It make you wonder….Are these super grans beating the benefit families, simply because they are genetically stronger, or mentally stronger, or just goddam stubborn. Perhaps these poor young people with all their obesity and pain is simply induced by a life of poor motivation….There is nothing to do but smoke weed and get fat, and when you smoke a lot of weed, you can’t work so you get broke (financially)  Broke v’s broken. Poor v’s poorly. Clever v’s just motivated .




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Posted on July 27, 2012. Filed under: Uncategorized |

The Olympics start in London tonight!!!  (Apart from the fact they have already started the footy, and already made a cock up showing the wrong flags…

It reminded me of last time with the increased accidents at home due to people competing with the TV 

“I often joke that exercises isn’t necessarily good for you…which leads me to the report that states arm chair spectators of the Olympics have been trying to compete…apparently a company that repairs gadgets has received around 50 calls from people wanting to set up their rowing machines and exercise bikes so they can practice keeping up with the Olympians.  My favourite quote in this article is from John Brewer of the Lucozade Sports Science Academy:

There has to be a degree of realism and common sense”

Oh my god….really.  Does this apply to everything in life!!!  Lets just hope they keep it to the rowing machine and exercise bike.   Otherwise it’ll be a case of…
“Honey, duck down I’ve just thrown my javelin in the kitchen….honey?… Sweety are you there??”
The ancient art of Javelin catching…”
 So how are things with Max? Yeah OK actually. I wish I had time to blog like I used to, but alas I just too darn busy!
Hope you enjoy the Olympics, and if you happen to be in the East end of London and hear gunfire, it MIGHT be a starting pistol!!
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Posted on January 26, 2012. Filed under: Uncategorized |

It shouldn't happen in health care

As I get a tiny bit older (not old, just older), I realise my perception of time isn’t quite right.  I see the patients date of birth and think…oooh they were born in 1994, and I look down the corridor expected some little kid with bunches and a cute smile.  Instead I am grunted at by a spotty, 6ft teenager…

My heart sinks…I like seeing cute kids, they are easier to communicate with than teenagers.  I realise the teenager is without parent….my heart sinks further…  I realise the teenager has bought one or more friends with her, there is a dull thud as my heart sinks so far it falls out of my shoe.

This happens on a regular basis, these “kids” are sexually active… and they want to see me to talk about “it“…kill me, kill me now…

Actually that gives the wrong impression.  I like educating people…

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Not quite goodbye.

Posted on July 14, 2010. Filed under: Uncategorized |

Just thought I should pop by quickly to let you know I am alive and well.

After the initial trauma of moving, my new consulting room flooding, getting 2 complaint from patient in the first month (after not having any complaints in years). I have adjusted to the new way of life.

I have more time with my kids in the morning, (not sure if that is a perk some mornings – on the subject of perks… they have a proper filter coffee at my new surgery – oh blissful bliss!!) I get home earlier in the evenings and in the school holidays the family can meet me at lunch, without having to make a day trip out of it. 

I have gone from being one of 3 NP’s to being the only NP, but I have learnt loads since being here. My new surgery is a teaching practice and so I crash in on some of the teaching from time to time and have fantastic light bulb moments…on the down side, they want me to do gynae stuff. I’ve made a career of avoiding it! (Pass the minors helmet!)

 “Alright love looks like a bit of BV from here!”

But all in all, it’s going well. The big downside is I have a shorter lunch time and not allowed to blog according to the IT policy, and I certainly don’t have time outside work to blog.  So as I warned post are going to be very thin on the ground, but I am too weak to break the bond completely. So maybe the occasional post might pop up!

Frankly darlings, I miss you!!!

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Posted on July 30, 2009. Filed under: Uncategorized |

The demographic of your patients is an important factor, and the sooner you understand the basics of it the sooner you can understand how the general populous tick!

Every street, village, town, city, county and country have a different demographic.  I think it is time I revealed a little about this one.  Lets call it Sickton-on-the-Naze!

Al worried about trimming his nasal hair!

Sickton-on-the-Naze is an old village that has gradually grown into a town.  Traditionally the general population is not very mobile – regardless of age.  I mean this in two ways…

Firstly – Literally not mobile – Zimmerframes. There is a LOT of old folks around here.  This is because very few people leave the area so they grow old here, it also has a high elderly population as people come here to retire.

Secondly – socially mobile.  It’s kind of miles from anywhere, so the folks that grow up in Sickton-on-the-Naze, seem to stay here. They don’t seem too bothered about getting a driving licence, the driving test centre is miles away.  If someone decided to leave and go to college it’s considered a major event.

Due to the culture of not leaving town, people don’t seem to consider it. They stay here with the crap jobs, little chance of promotion, and little expectation. 

Before I start to sound too snobby I would just like to clarify something – I love it here.  From a clinicians point of view it is an interesting place to work.  The people in general are lovely. Sure we have a fair few drug addicts and lots of little old ladies and even a few little old lady drug addicts!  It makes for an interesting day.

The sad thing is that we seem to have a lot of young women who are stuck here and really should be bound for better things, but just don’t consider it.  With obviously some exceptions, the young men seem to be unmotivated and quite ugly, but do alright for themselves in the love stakes as the young women don’t considering casting their love net a little further out to sea.   So if you are an ugly bloke with poor prospects who wants a pretty girlfriend, this really is the place for you.

We also have a few great stereotypes and they probably exist in every surgery across the country. 

We have the Colonel. 

His grandfathers grandfather founded the town and half the streets are named after his dogs. He went into the military and enjoyed blowing things up, and still sometimes forgets that he has left active service and thinks that motability scooters are enemy tanks and takes pot shots at them with his air rifle.

We also have several old ladies who previously had high powered jobs, in the times before ladies were supposed to have high powered jobs.  The type of  woman the Colonel likes to call “Bloody lesbians”, despite the fact they are infact widows. Now with free time on their hands and their minds still agile they decide they can take on the world again and “fight for the little people”.

“Unhand me…I’m not a lesbian!”

We also have a few eccentric old ladies. One of which brings all the Doctors a banana every-time she passes by, and writes messages to them on the skin.  Then there is the lady who denies she has dementia and every-time you mention it to her, she informs you that “nobody ever mentioned it before”.  My personal favourite is a eccentric variant of the previously mentioned high powered ladies, that are waiting for a good murder for them to solve…

.…”Why won’t anyone come on holiday with me?”

oooh, and the 78 year old nurse who still receives a wage from a nursing home where she helps “the old people”, some of which are considerably younger than she!

…and that is why I love my job!

Just added my “Rate this” stars at the top…feel free to use them, so I can get a bit of feed back into what type of post you like best!  I’m insecure and need your help!

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Busman’s Holiday?

Posted on October 9, 2008. Filed under: Uncategorized |

You know it’s time to have a break from work when your 3 year old hurts her ankle and says she got a sore lateral malleolus…

So we decided to go away, I thought this week I’d stay away from any physiology and anatomy and tell you about my holiday instead…

We decided to go abroad, and with airport parking so expensive we decided to get to the airport by train.  My daughter was keen to go on the underground, so we went on the Eustachian Tube then somehow connected with the Fallopian Tube and finally Central Line to Standstill airport.

The London airports are named after the villages they have ruined, rather than other airport which are named after famous people like John Lennon airport in Liverpool, or the John F Kidney airport.  Airports make me nervous…it’s all to do with the use of the word “Terminal”…as in…not going to live.

The flight was smooth, with Wallace and Grommet as the in-flight film. We arrived on our Mediterranean island hopping holiday.  We were spending the first half on the larger island of Labium Majus, and then going on a Crus to Labium minus.  My wife was sure if we spent enough time on the island we were bound to find the right spot eventually.  We bought an atlas and a tourist guide that had an in- depth appendix

One day we took a day trip to the isle of langerhans and had a gland day out.  They had an activity centre there were we took a Artery course.

Whilst away we tried several of the local dishes, such that lovely filled pasta – alveoli and that lovely Spanish fish and rice dish – patella, and drank some lots of wine, including a superior vena cava, much better than the inferior cava in the supermarket! I orta try that again.

Mostly it was a lovely holiday, the only complaint was at the first hotel was noisy as there were some building works going on, and they started early every morning, I was told not to complain about it as the builders had a mental foramen in charge, and I didn’t want to get on the wrong side of him.

We had a nice relaxing holiday, perhaps next year we’ll go through the carpal tunnel to France.

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OK it’s my own fault…

Posted on September 18, 2008. Filed under: Uncategorized |

I should know better but last week I said it was “Quiet”.

I’ve worked in health care long enough to know that this means there will be an impending disaster.  In the Emergency Department, staff would be disciplined for even using the Q word. The use of this word or similar normally meant that the “hot phone” was about to ring, (and no it wasn’t “The banker”)

If a butterfly flaps it’s wings in China the repercussion will be a tornado somewhere else in the world. (Trust me Emergency nurses know all about Chaos theory…)

Whereas if a Nurse says the Q word in hospital the subsequent repercussions will include a multi-car pile up and 5 cardiac arrests before the next shift starts.

So yes…I should know better, I’ve even discussed the topic before in P=Q-D/C/BM (and you thought chaos theory was confusing).

Anyhow the short and curlies of it are this…it’s been busy, I’ve got myself paperwork and chores and precious little time to do much else….alas here endeth the blog for this week….but if you want a giggle and some education I particularly liked this post from Rob this week…so if you are quie…..not too busy, have a read…

or nose through the archives…how about “Do no Harm!”


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