The Night Mail

[jjb1970]

8 hours ago, iL Dottore said:

I am gobsmacked.
 

One of the first things you learn when doing abdominal surgery is that before you close up, the entire abdominal cavity has to be squeaky clean*. Which means the bowel is checked from top to bottom to see if there are any missed perforations, the entire abdominal cavity is sluiced out with normal saline (they used to add a wide spectrum antibiotic to the normal saline when I was a wee student, I’m not sure if they do that nowadays) and when the lavage came out clean, then you could start closing up. And given that the last thing you want is a few errant E. coli setting up a breeding colony in a patient’s  abdominal cavity, you monitor the patient VERY carefully for infection.

* admittedly not always possible - especially after major abdominal trauma

Not having really thought much about abdominal surgery for many, many years, I don’t know what is an acceptable level of “infection markers“ (which I presume are actually inflammation markers - such as CRP or Procalcitonin, which are also altered in other diseases or certain hæmatology tests - such as leukocytes or hæmatocrit - again also altered in other diseases, not just infections). I know that current surgical practice is to get patients ambulatory as quickly as possible post surgery and then discharge to home, also as quickly as possible – but I certainly wouldn’t sign off on a discharge note unless I was 100% convinced there is a very low probability of the patienr returning with an exploding belly…

 

You were, to be blunt, bloody lucky: Approximately 30% of patients admitted to an ICU with intra-abdominal infection succumb to their illness (range 5% - 50% depending upon a number of factors. [data from a 2022 review available via PubMed])

 

They only told me how sick I'd been when I was ready to be discharged, apparently the drugs they were using were the most powerful tools they had in the box and that if they hadn't worked I would have been in real trouble. I honestly don't know anything about infection markers, it's just the term that stuck in my mind as it is what the doctors discussed every morning, though I never read the blood test reports I did look at what the doctors were looking at and it seemed a very comprehensive set of tests. I felt sorry and embarrassed for the nurses, I had various drains around my stomach which for several days were filling up at quite a rate, when the nurses had to change over the drain bags even though they could shut them off the smell was truly putrid from the residual slime in the tube as they swapped over.

The one thing I was disappointed by was that the hospital never acknowledged the first wash out hadn't been good enough. Maybe they're worried it amounts to an admission in the case of a legal claim or something but I wasn't interested in blaming anyone. I'm reminded of the gospel of John and letting the person without sin cast the first stone. I have made countless mistakes at work in my life and I really wasn't angry about it. They cleaned up the mess and put it right and I'm sure it wasn't deliberate. The surgeon who did the second operation explained it in one of his post-op checks and it was in the discharge letter, it wasn't hidden from me so I don't want to try and insinuate there was some sort of cover up as there clearly wasn't, and as weird as it sounds in the circumstances I genuinely had no complaints about the first part of my experience when the appendix was removed.

For all that, it has left me with a lot more awareness of the risks of appendicitis. We're always told how risky a burst appendix can be but because it is one of those surgical procedures which is so routine (noting that no surgery is risk free) and people tend to be released very quickly after the operation it's easy to get complacent about it. I discovered the hard way that appendicitis can get very messy and potentially life ending. Not nice at all. So for people still with their appendix, remember, if you start getting pains and cramps in the area see a doctor.

Edited September 25, 2022 by jjb1970

[jjb1970]

1 hour ago, pH said:

Canadian Social Insurance Number is supposed to be used only for communication with government departments. However, various other organizations ask for it. You can refuse to give it, but the response is likely to be “Well, I can’t help you, then.” 

 

That's very common, use of proxies such as driving licenses, national insurance numbers and passports in place of ID cards. In the UK it is now a standard part of day one in a new job (if not done before starting) to show your passport to your line manager or someone in HR so it can be copied and filed as part of laws intended to ensure only persons legally entitled to work in the country are employed, but that assumes you have a passport. There is no legal requirement to have a passport, there will still be people who don't drive and who have no intention of going to other countries and so have neither. These people might be told that even if they have no intention of travelling they should get a passport so they have a means to demonstrate their identity' which almost turns passports into a de-facto form of ID card. As I say I'm not so much an enthusiast of ID cards, rather in an era of so much tracking and when proxies such as driving licenses and passports are used as de-facto ID cards we may as well just recognise reality and issue the actual cards.

[iL Dottore]

9 hours ago, polybear said:

 

As well as the ability to monitor a lot more patients simultaneously.

 

 

Bear recalls SiL (who was a Ward Sister) saying that if you are in real trouble (unexpectedly) then it's much better to be on an open ward than in a side room - the latter get very cramped, very quickly when all the required staff and kit start piling in trying to save you.....

Many, many decades ago when I was but a wet-behind-the-ears student, in the hospital I worked at patients who were unstable/critical were always treated in high dependency units (such as the ICU or CCU) and only moved to a standard hospital room when the clinicians and nursing staff were satisfied that the patient was stable and did not require intensive monitoring/supervision.

 

And whilst it is true that there is more space on a multi patient ward than in a standard hospital room, it really doesn’t make a very big difference – there’s only so many people that can get around a standard hospital bed at any one time even in an emergency (been there, done that, got the T-shirt).

 

I take the point that some people do like having company whilst hospitalised. I am very much the opposite: at the best of times I am a cynical, grumpy, antisocial so-and-so and I’m even more so when hospitalised – I can just about put up with a single (hospital) roommate and even then it’s pushing it!

Edited September 25, 2022 by iL Dottore

[iL Dottore]

2 hours ago, jjb1970 said:

….The one thing I was disappointed by was that the hospital never acknowledged the first wash out hadn't been good enough. Maybe they're worried it amounts to an admission in the case of a legal claim or something….

Interesting that you should say that, quite recently I was reading an article in an American on-line journal about how best to manage a medical practice and it was recommended that when mistakes are made it is best to admit to them and to state what steps will be taken to remedy the situation. And this was advice given in the home of the ambulance chasing lawyer (according to one book, in 1995 – so sometime ago – there were 34% more lawyers than doctors in the US! Things have probably gotten worse since then)

 

In my view, for what it’s worth, the moment they (whomever “they” may be) try to start covering up medical mistakes is the moment when mistakes become malpractice.

Edited September 25, 2022 by iL Dottore
Typo

[jamie92208]

9 hours ago, Winslow Boy said:

 

Aaaaarrrrggggh!!!!!!!!!

 

Runs screaming from the room.

What's wrong with painting concrete.  Over the last 6 years I've spent several days painting 300 square metres of the shed floor.  It does help keep the dust down.  Only another 100 to go when we finally clear the top end.

 

Anyway, yesterday I ventured north to Chatellerault to a large model show in the exhibition centre that they have there.  5 halls and 2 outdoor areas.  One of the latter was a large RC car track and the other was a pond for boats. Lots of models of all kinds, buildings, boats, planes and trains in the various places.  Quite a fw good traders for tools and model railways but no traders for model boats or planes.   One hall was reserved for flying planes indoors.   There was even this flying around.

It was being buzzed by no less than three small planes, one of which landed on top of it.

In the train hall half of the space was the annual show by the Cercle du Zero of which I'm a member.  there was some fabulous modelling.

This layout had a beautifully detailed coaling stage.

There was also a big roundy roundy that had a loco shed on one side.

The coaling stage was even more impressive.

Plus some lovely locos in the yard.

There was also temptation.   One of the stands was a group that model French Metre gauge and they had details of a kit for an 0-6-0 tank of the type that used to work through our village until the early 50's.  A conversation about the kit led me to another layout based on 0n30 stock and set in California.  This was the lumber mill.  The owner took the roof off for me to have a look.   

 

He has built one of the aforementioned tank engines and has some kits of the rolling stock for sale.  

Get thee behind me Satan was said but a leaflet made it's way into my rucksack. The village station still exists and I do have some photos............

 

Jamie

 

 

 

 

 

 

 

 

Edited September 25, 2022 by jamie92208

[polybear]

6 hours ago, pH said:

Canadian Social Insurance Number is supposed to be used only for communication with government departments. However, various other organizations ask for it. You can refuse to give it, but the response is likely to be “Well, I can’t help you, then.” 

 

The Canadian Gov. should be clamping down on such organisations methinks

 

4 hours ago, jjb1970 said:

 

They only told me how sick I'd been when I was ready to be discharged, apparently the drugs they were using were the most powerful tools they had in the box and that if they hadn't worked I would have been in real trouble. I honestly don't know anything about infection markers, it's just the term that stuck in my mind as it is what the doctors discussed every morning, though I never read the blood test reports I did look at what the doctors were looking at and it seemed a very comprehensive set of tests. I felt sorry and embarrassed for the nurses, I had various drains around my stomach which for several days were filling up at quite a rate, when the nurses had to change over the drain bags even though they could shut them off the smell was truly putrid from the residual slime in the tube as they swapped over.

The one thing I was disappointed by was that the hospital never acknowledged the first wash out hadn't been good enough. Maybe they're worried it amounts to an admission in the case of a legal claim or something but I wasn't interested in blaming anyone. I'm reminded of the gospel of John and letting the person without sin cast the first stone. I have made countless mistakes at work in my life and I really wasn't angry about it. They cleaned up the mess and put it right and I'm sure it wasn't deliberate. The surgeon who did the second operation explained it in one of his post-op checks and it was in the discharge letter, it wasn't hidden from me so I don't want to try and insinuate there was some sort of cover up as there clearly wasn't, and as weird as it sounds in the circumstances I genuinely had no complaints about the first part of my experience when the appendix was removed.

For all that, it has left me with a lot more awareness of the risks of appendicitis. We're always told how risky a burst appendix can be but because it is one of those surgical procedures which is so routine (noting that no surgery is risk free) and people tend to be released very quickly after the operation it's easy to get complacent about it. I discovered the hard way that appendicitis can get very messy and potentially life ending. Not nice at all. So for people still with their appendix, remember, if you start getting pains and cramps in the area see a doctor.

 

I hope that at the very least they've learnt a very good lesson following your ordeal and get their act together very quickly.

 

 

 

 

[Winslow Boy]

20 minutes ago, jamie92208 said:

What's wrong with painting concrete.  Over the last 6 years I've spent several days painting 300 square metres of the shed floor.  It does help keep the dust down.  Only another 100 to go when we finally clear the top end.

 

Anyway, yesterday I ventured north to Chatellerault to a large model show in the exhibition centre that they have there.  5 halls and 2 outdoor areas.  One of the latter was a large RC car track and the other was a pond for boats. Lots of models of all kinds, buildings, boats, planes and trains in the various places.  Quite a fw good traders for tools and model railways but no traders for model boats or planes.   One hall was reserved for flying planes indoors.   There was even this flying around.

It was being buzzed by no less than three small planes, one of which landed on top of it.

In the train hall half of the space was the annual show by the Cercle du Zero of which I'm a member.  there was some fabulous modelling.

This layout had a beautifully detailed coaling stage.

There was also a big roundy roundy that had a loco shed on one side.

The coaling stage was even more impressive.

Plus some lovely locos in the yard.

There was also temptation.   One of the stands was a group that model French Metre gauge and they had details of a kit for an 0-6-0 tank of the type that used to work through our village until the early 50's.  A conversation about the kit led me to another layout based on 0n30 stock and set in California.  This was the lumber mill.  The owner took the roof off for me to have a look.   

 

He has built one of the aforementioned tank engines and has some kits of the rolling stock for sale.  

Get thee behind me Satan was said but a leaflet made it's way into my rucksack. The village station still exists and I do have some photos............

 

Jamie

 

 

 

 

 

 

 

 

 

Horses for courses as they say re the concrete painting. I can see the the practicality of painting the floor of a shed , I have some paint to do the same in a garage. It has been sitting on the shelf though for some time as I can never actually get round to emptying the garage to do it.

 

Those a some fantastic layouts. Particularly the timber yard. Do I need to say don't weaken or is it to late.

[jjb1970]

On the question of hospital wards and being left alone vs enjoying the company of others, I think that is very much a personal choice and we will all be different. And I think it will also vary with condition. I must admit I was happy to be left alone, I was in a multitude bed ward but maybe because people could see I had tubes inserted all over the place and was not feeling too clever I was left alone.

Something I would say is that my phone was a god send. I know it's easy to criticize people who go through life glued to their phone but I found it made a huge difference. The hospital had WiFi and it meant when I was in the mood I could listen to music, watch TV & movies, read books on the Kindle app etc. That made a huge difference to the experience. 

[simontaylor484]

I have my garage floor to seal at some point just need to get more stuff out. I am waiting for a bathroom refit too so they may need some storage space 

[Northmoor]

6 hours ago, jamie92208 said:

This layout had a beautifully detailed coaling stage.

 

Some exquisite modelling on show there.  Isn't this one in the second image, an LSWR B4 tank?

[jamie92208]

1 hour ago, Northmoor said:

Some exquisite modelling on show there.  Isn't this one in the second image, an LSWR B4 tank?

No idea I'm afraid.

 

Jamie

[Gwiwer]

26 minutes ago, jamie92208 said:

2 hours ago, Northmoor said:

Some exquisite modelling on show there.  Isn't this one in the second image, an LSWR B4 tank?

No idea I'm afraid.

 

It does look like it although many a British design was also produced or adapted for sales abroad and some UK locomotives were later sent to work overseas.  As indeed is still the case today with classes 66 and 92 among others. 

[Compound2632]

13 hours ago, jjb1970 said:

almost turns passports into a de-facto form of ID card. 

 

And an expensive one at that - but cheaper than a driving license once lessons and test fees are taken into account. There's a lot of presumption that everyone has not only one or both of these but also a smartphone - a clear sign of lack of social awareness on the part of the rule-drafters. 

[petethemole]

13 hours ago, jjb1970 said:

 

That's very common, use of proxies such as driving licenses, national insurance numbers and passports in place of ID cards. In the UK it is now a standard part of day one in a new job (if not done before starting) to show your passport to your line manager or someone in HR so it can be copied and filed as part of laws intended to ensure only persons legally entitled to work in the country are employed, but that assumes you have a passport. There is no legal requirement to have a passport, there will still be people who don't drive and who have no intention of going to other countries and so have neither. These people might be told that even if they have no intention of travelling they should get a passport so they have a means to demonstrate their identity' which almost turns passports into a de-facto form of ID card. As I say I'm not so much an enthusiast of ID cards, rather in an era of so much tracking and when proxies such as driving licenses and passports are used as de-facto ID cards we may as well just recognise reality and issue the actual cards.

My son, who has autism and has had difficulty finding work, lost out on at least one job through not having either passport or driving licence (he has no intention of driving and his old PP had expired).  At the same time foreign nationals with appropriate documentation were being employed.  Now I have no problem with anyone working here, but only a few years ago he would have needed neither, only a birth cert. for some employers.  He ended up getting a provisonal DL and is about to start a new job.

[Happy Hippo]

The final segment of deep trench was dug this afternoon.

 

Tomorrow i'll completely isolate the armoured cable; cut it, move the old outdoor socket to the new location and then reconnect it all and reapply the power.

 

Then I can start filling the trench back in.

 

Dig a hole then fill it back in: It's like being on exercise at Sandhurst.

[Gwiwer]

6 minutes ago, Happy Hippo said:

Then I can start filling the trench back in.

Sounds like a lost opportunity there.  Filled with water it might have made a perfect muddy hollow

[Tony_S]

20 minutes ago, Gwiwer said:

Sounds like a lost opportunity there.  Filled with water it might have made a perfect muddy hollow

If it rains tonight it could become one anyway. 

[jamie92208]

4 minutes ago, Tony_S said:

If it rains tonight it could become one anyway. 

Like our new soakaway is doing at the moment.

 

[Happy Hippo]

39 minutes ago, Gwiwer said:

Sounds like a lost opportunity there.  Filled with water it might have made a perfect muddy hollow

Alas it was, but Nyda is keen for any new water features to be visible from the terrace. 

 

I have some pit in the lawn where the 'fairy ring' was removed.

 

Underneath this fungal disaster zone was a set of Ash roots which were just below surface level.  They were following the course of least resistance as the ground bbelwow is compacted clay. (The roots probably contibuted to the creation of the ring as it would have disrupted the lawn and been very good at absorbing any moisture.)

 

The removal of the rings  has created holes deep enough to start a series of small ponds should I so desire.  this would create a waterway so I could move from one end of the garden to the other without having to get dry.

[rockershovel]

On 24/09/2022 at 18:26, iL Dottore said:

Why is the NHS still wedded to the idea of the multipatient ward? Definitely an obsolete concept, I would argue.

 

In Switzerland the standard is generally two patients to a room (although some university hospitals may have up to 4 patients to a room). The only multi bed units in common use across Switzerland are those high dependency units – such as an ICU, step-down ICU, CCU, etc - where monitoring is very, very intensive (e.g. vital signs q 15 minutes)

I imagine that it is probably due to the number of 1960s buildings still in use. 

 

 

[New Haven Neil]

Today I have been mostly....

 

 

 

Fair cracking along at 20mph on 15 inch gauge feels well fast, 8 on and full, plus a superb display of enginemanship from my young friend Ryan, who is not yet 30.  Old River Irt can still cut the mustard, doing a job her designer in 1893 could never have imagined.

[SM42]

We are 3/4 floored here and still relaxing in half of the lounge while the other half is a work site. 

 

Still a lot to do, especially with a paint brush. 

 

I had hoped to paint before the flooring went down , but I lost a lot of time  awaiting official sign off on paint  colours. ( BR blue, crimson lake and GW green were early casualties of the selection process. BR  lined black didn't even get a chance to have the chance to be deselected)

 

The B&Q tarpaulins will have to be deployed again. 

 

Andy

Edited September 25, 2022 by SM42

[Northmoor]

Today i have been doing my second boot sale of the year.  Nice weather (cool but sunny) and a steady, almost continuous stream of buyers for over four hours.  As almost everything was priced at 50p or a pound, only making £23 "profit" isn't so bad, I've probably cleared a whole crate out of the garage.  

What is always baffling about car booting is how some items are ignored one time then there's a rush of interest the next.  I've had a bunch of rugs that been back and forth to I think five sales; I was seriously considering taking them to the tip after this weekend, but today I sold four of them at £3 each. 

[Winslow Boy]

3 hours ago, Happy Hippo said:

The final segment of deep trench was dug this afternoon.

 

Tomorrow i'll completely isolate the armoured cable; cut it, move the old outdoor socket to the new location and then reconnect it all and reapply the power.

 

Then I can start filling the trench back in.

 

Dig a hole then fill it back in: It's like being on exercise at Sandhurst.

 

You do know how to enjoy yourself don't you Big H.

[simontaylor484]

Sounds like @Happy Hippo is building his own canal, a couple of narrowboats pootling up and down. Makes a change to a garden railway