The Colors of Dreams

A Spring clean in the Sandnsurf household is an unusual phenomenon at the best of times. The most recent such event was made all the more remarkable by the fact that i) it occurred in summer and ii) that it was actually useful. I stumbled upon a beautiful poem written by my good friend William Fiennes from 1991.

A wonderful reminiscence - that I just had to share...

click on the poem to enlarge

A colleague just reminded me of one of my favorite 'letters' published in The Courier Mail, Queensland, Australia on May 04 2008. It pertains to the workings of the emergency physician. For more information on emergency medicine and waiting times - read Primum Non Nocere...

Dear Potential Patient, I work in a public hospital emergency department, so that means any time you are in my part of the world, you are potentially my patient - you, your family, your friends. Tomorrow could be the day that a bad thing happens to you and your life is changed forever. That heart attack you knew was coming sooner or later, the crash on the freeway, the toddler found face-down in the swimming pool. Tomorrow, you could be rushed to my hospital - and I'll be doing my best to help you.

But, as your doctor, I have to warn you: things are not good.

I'm a Queenslander born and bred and have worked in public hospitals since 1982. I am a specialist in emergency medicine. My team and I save people's lives for a living. We are good at it, and enjoy it. We deliver first-class emergency care to Queenslanders and those visiting (yes, tourists, I'm your doctor, too). I've travelled enough to know our state has a fantastic emergency response service and I'm proud to be part of it. Queenslanders expect it and you deserve it. So what isn't good? Put simply, our emergency departments - the place every ambulance rushes to - are already clogged with people. You'll notice that from the time you arrive. It may be some time before we can find a space for you. Only the sickest people get immediate attention: the ones who can't breathe, the ones who are unconscious. If that's you tomorrow, I'll see you as soon as you arrive and I'll use my skills and experience to stop you from dying, work out what's wrong with you, give you the immediate treatment you need and then move you on to another doctor who specialises in your kind of problem. You usually don't remember me, but I don't mind. If I smile when I see you in the hospital kiosk next week, it's because I like seeing a good result.

For everyone else - I'm sorry about the wait.

We try to be thorough and that means taking time with every patient. When it is your turn you will get the same treatment. But although year-on-year more people are seen in emergency departments across the country, that's not the only reason we're clogged with patients. A bigger problem is that we can't get people out of the emergency department. Hospitals (public and private) often have no available inpatient beds, no available intensive-care beds, or no available coronary-care beds. Often, very sick patients stay in my emergency department until a bed somewhere comes up. Sometimes that takes hours or even days. They stay in the beds we need for the people coming through the door. We don't have rubber walls. Somebody has to suffer. Patients on trolleys are in the corridors, and there they stay until a free bed is found. Sound dangerous? Sure is. I am making life and death decisions in an overcrowded noisy chaotic environment, and it is your life or death I am deciding about. No wonder we're both stressed. As your doctor, I warn you that when you come to my emergency department tomorrow your experience may not match All Saints with a neat solution after 47 minutes plus ads. I will do the best I can to keep you alive and get you where you need to be. That's all I can do. Since you are going to be my patient tomorrow, I have requests for some of you:

• TO THE 28-year-old salesman whose car hits a tree after the party tonight: You can't drive better with a few drinks under your belt. And don't take your mate's girlfriend for a spin; after tomorrow, she'll never look the same again.
• TO THE 78-year-old male retired railway worker with chest pain: I know your GP is very familiar with the medicines you take, but I will need to know in a hurry and sometimes it's hard to get through to the GP. Please make a list of your usual drugs and keep it up to date.
• TO THE 42-year-old businessman: Don't tell people you're going to kill yourself if you don't mean it, especially if you're drunk. It will take hours before I can talk sensibly to you and, yes, you do have to stay in my department all that time. And you have to have a blood test. Really.
• TO THE 19-year-old student, nine weeks pregnant and bleeding: We know how upset and worried you are. We'll get you into a bed soon. But mostly, what happens will happen, whether we get you into a bed or not. But we'll still try.
• TO THE 85-year-old retired coalminer and respiratory cripple: We have the technology to pull you back from the brink over and over, but it's like skipping a stone - each skip is shorter and lower than the last and eventually there's not a lot to be gained from skipping again. When a few more days or weeks aren't worth the needles, the tubes, the masks and the whole carry-on, let me know. Say you don't want to do it any more. I will look after you. But don't wait until tomorrow, because by then you'll be on the brink again and too starved of oxygen for me to listen to you. No matter what you say then, I will resuscitate you. You need to tell it to your loved ones now. Then tomorrow, when you tell me you don't want to be resuscitated, that you want comfort measures only, I can check with someone who knows you and I will do my best to follow that wish.
• TO THE 35-year-old female shop manager with recurrent abdominal pain: Please see your GP again before coming to us. Yes, we deal with belly pain, but your GP is well on the way to discovering what is wrong with you. Please persist with him or her. If you come to see us we'll just have to start all over again.
• TO THE 21-year-old male: Don't inject speed. If you act psychotic we will need to treat you, even if you don't want it. Please don't hit us, bite us or spit on us, we are only looking out for your best interests.
• AND finally, to the 53-year-old Queensland Health senior manager: We are drowning down here in the emergency department. I am your doctor, too, and I am tired of waiting for the problem to be fixed.

Quality emergency care is critical for all of us. It's in everyone's best interest to get my department cleared and functioning optimally. I want space, I want staff who can do this job well, and I want time to train them. The situation needs some action now. We are all at risk. To other doctors: I am your doctor, too. Please help me when I ask you for help with a patient. I'm not doing it to spoil your day. I've got other patients and there's nowhere else to go. Politicians and powerbrokers: I am your doctor, too. I know you have private medical cover; I know you have a good GP and other specialists who look after you well. But tomorrow it may be you who collapses while walking the dog or it may be you collected by the BMW that lost it on the corner. No one is going to check for a private health insurance card. They'll bring you to me and I'll be your doctor then. How prepared and capable do you want me to be? To all of you who are my patients: I am doing the best I can under the circumstances. I can't save everyone. I can't be right every time. I won't be able to get to you as quickly as I would like, and nowhere near as quickly as you would like. And please be understanding. It's hard enough keeping you alive without being abused while I'm doing it.

The doctor's identity has not been revealed by his request.

Check out the full article form the paper - the comments are great or For more information on emergency medicine and waiting times - read Primum Non Nocere...

Just completed a weekend of 'homework projects' - not of the DIY variety, but the kids 'leave it till the last minute and then ask Dad' - variety. Being slightly computer centric I felt the quickest and easiest way to assist in the projects would be to let the little fella's loose on the Mac. However, a couple of misspelt Google searches on the schools chosen topics of research 'Thorny Devils' - and the kids were banned from the room until I could find a more appropriate Kid-friendly search engine... The search was intended to highlight the plight of the Australian Thorny Devil (Moloch horridus) - but this was variably remembered and typed as 'horny devil'; 'horny toad' or 'horny lizard'. The search results were just as varied and on one occasion was I forced to avert their eager eyes with a more wholesome temptation (chocolate)

• Standard Toolbar Search from
• Homework Tools: Dictionaries, museums, maths, grammar and other useful sites
• Page of the day - In this case 'Kids Health' ages 6-12, which provided fantastic simple and well illustrated explanations relating to common questions kids have about health and disease
• Kids easily understood the four options for search from the home page. No results for our 'horny' project - but later searches returned results which were relevant, useful and age appropriate.

• Unique word cloud search with words 'clicked' appearing in search bar
• Ability to search for TV, movies, Sports, computers and games
• Short results page with icons and large text
• Kids loved the ability to search with the Quintura word cloud and the 'horny' problem was easily rectified. Results were accurate, age appropriate and infomrative

• Standard search bar
• Heavily filtered - unable to search for the word 'horny' or 'thorny'
• Results simple to refine - certainly easier to search on a single word and then drill down deeper by using one of the 15 refinement buttons
• Unable to find our required Australian lizard form the search bar. However, there were lots of high quality results for our other searches and all age specific and well filtered.
• Certainly be happy to have this engine filter search results - however, not convinced they would have much left to search due to the weight of the filtering restrictions

Ask Kids.com

• Simple search bar with additional ability to refine by images or videos
• Schoolhouse provides maths, science, history and the arts and can be filtered for age group (kids, teens, advanced teens)
• access to the International Children's digital Library - a huge resource for children's literature
• Excellent results for Thorny devil - having rejected the word horny as inappropriate

FamHoo.com (Fam = Family; Hoo = exclamation of joy!)

• Standard Search Bar
• Simple search results - with no keyword highlighting so still too complicated for my kids
• Found the results for our searches to be far from useful
• Tried the 'Pamela Anderson' search as per AltSearchEngines and two clicks later (following the 'photo link' to allmovies.com then clicking on celebritywonder.com) my 7 year old was playing Celebrity BoobMatch!!

Alternate Meta-Search Engines

• Ivy's Search Engine Resources: Internet search engine links, links to web guides for kids, some specialized search engine forms and specialized search engine links of interest to kids.
• Search-22 Kids Search Engine Search-22 provides direct access to some of the thousands of search engines you have probably never heard of. It allows you to write your query one time and get the results from different resources by clicking the different search buttons.

Happiness begets happiness...especially if you are central to the causation of happiness. A study from Harvard University and the University of California, San Diego found that 

People at the center of the social network tend to be happier...and they are more susceptible to the waves of happiness that spread throughout the network.

To study the spread of emotion, the researchers plotted out the social connections of about 5,000 individuals enrolled in the ongoing Framingham Heart Study. To measure 'happiness' the study reviewed the participants feelings over the previous week "I felt hopeful about the future," "I was happy," "I enjoyed life," "I felt that I was just as good as other people." This has been shown to be a valid instrument for measuring positive affect and it has been taken as interchangeable with the concept of happiness. The study authors defined "happy" as a perfect score on all four questions. Listen to this commentary on 'the spread of happiness through a social network' or watch the great visual review

When one person becomes happy, the social network effect can spread up to 3 degrees — reaching friends of friends.

According to the new study on happiness and social networks, your probability of being happy rises:

• 15.3 percent if a friend or family member is happy
• 9.8 percent if friends of your friend or family member are happy
• 5.6 percent if friends of the friends of your friend or family member are happy

With the advent of Twitter and multiple other dynamic online social networking groups - we should hope to see an exponential growth in happiness in the very near future. How about a Twittappy Day - sending a 'happiness is Twitter' greeting to all your Tweeps should bring an enlightened surge of joy pulsating through the framework of social network ..bring it on

Happy Twittappy Day. I am happy, I am hopeful about the future, I enjoy life and feel I am just as good as other people http://short.to/bdf

Supporting the 'Free Hugs Campaign', 'SickPuppies.net', listening to Ivor Cutler and adding the synergistic 'Happiness is Twitter' should have a profound effect!

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From time to time you read an article and think - WOW - and, just like watching a softly falling feather you are mesmerized, filled with anticipatory thought and expectant cogitation - a veritable emotional stew... One such article was written by my mentor Professor Anthony Brown and first published by Blackwells Synergy - Emergency Medicine (2000) 12, 349–351. I reproduce the mainstay of the essay with the authors permission to increase the readers understanding and emotional rationalization

I'll read to you if you don't do your chicken wings...

These fateful words still ring in my ears and raise a lump in my throat. I no longer say them, but over Christmas 1995, I used to cuddle up to my son Edward, then aged 5 years, and bargain with him. I would read from his favourite books, but only if he sat still. Invariably he would smile with excitement, then jerk his head up and down, sometimes jarring his teeth together, shoot his legs out and eventually raise both his arms, elbows crooked and press them against his chest repeatedly, like wings. These complex movements would often recur many times an hour. No matter how much I pleaded, cajoled, insisted, demanded, gave in, they happened. Some occasions I stopped reading and walked off. How I hate myself now, for my defiance and lack of understanding. Me, a specialist, avariciously reading article after article to stay at the cutting edge of emergency medicine, yet so ignorant in real life. It was not until two years later that the diagnosis of Tourette's syndrome was made. 1997 was deteriorating into an annus horribilis. Edward had been in hospital for weeks with a severe septic arthritis of the hip, we sold our over-capitalized house and my brother-in-law in England needed chemotherapy for non-Hodgkin's lymphoma. One evening my wife Regina rang me in tears, whispering she finally knew what was wrong with Edward, after watching a television documentary on Tourette's syndrome. I did not believe her, nor did the neurologist we saw in September, whose neurological examination was swift and technically flawless, but who totally failed to communicate any sort of reassurance to my wife or me. In December we saw a child and adolescent psychiatrist, who could not have been a greater contrast. His gentle, authoritative, listening approach released our tears of relief coupled with sadness, as the diagnosis became unequivocal. Multiple, distressing, complex motor tics for over 12 months duration, with impulsivity, task-completion block, outbursts of anger but no coprolalia at present (the uttering of obscenities that everyone knows Tourette's for - that is rare, occurring in under 10% and at a later, mid-teenage stage). We felt relief that there was an explanation for our beautiful child's behaviour, and that the fear of the unknown that had conjured up the spectre of a brain tumour or a relentless neurodegenerative disorder could be laid to rest. Sadness because it had taken so long to recognize despite several visits to our GP; sadness because we had tried to fight it; and sadness because we suddenly felt our bright, intelligent, busy boy was forever broken. My guilt and anger about not being there for Edward and Regina the night he had the first of several operations on his septic hip, as I was overseas briefly, were replaced by feelings of despair and helplessness that now Edward had a chronic, insidious, poorly understood illness, whose nature we had been oblivious to for so long. Tourette's syndrome has become a part of our life, an integral fact of our family dynamics. I have read Oliver Sacks 'The Man who Mistook his Wife for a Hat' and 'An Anthropologist on Mars' that help to demystify, inform and hopefully improve the public's image of this condition. I have discovered that Dr Samuel Johnson, Tolstoy's brother and the member of the hit 1960s band Herb Alpert's Tijuana Brass who could not keep still all had Tourette's; and I have studied Mary Robertson's book 'Tourette Syndrome: the Facts' (Oxford University Press, 1998). I now know that Tourette's syndrome affects 5-50 per 10 000 population, males outnumbering females four to one, children to adults by ten to one. Ninety per cent of cases have a familial tendency with complex genetics favouring an intermediate, multiallele gene with high penetrance and greater severity in the homozygous state, and that there is a clear overlap with obsessive-compulsive disorders (OCD, that more commonly manifest in females with Tourette's) and attention-deficit/hyperactivity disorders (ADD and ADHD). We have given educational material to Edward's school teachers in general and talked to his class teacher in particular about strategies to improve learning and socialization of Tourette's children in school-based settings, some drawn from John Piacentini's work at the UCLA School of Medicine. This focuses on creating a safe, understanding environment, with explicit, simple, single tasks or instructions, repeated and reinforced by praise not chastisement. Most of all, Regina and I have encouraged Edward to learn and recognize that he is not odd, but that he has a movement disorder called Tourette's syndrome due to 'an imbalance of inhibitory GABA and excitatory glutamate receptors in certain areas of the cortex, striatum, ventrolateral nucleus and thalamus'- I said this tongue-in-cheek to him once, and his naturally inquisitive, science-orientated mind seized these data with relish. Edward continues to perform well at school, and is envied for his prodigious reading capacity and ability to recall information. Ever since he did a 'Show and Tell' to his class about Tourette's shortly after the diagnosis was first made, he has been accepted and accepting. However, we are acutely aware of the need for children to fit in with their peers, and of the frailty of self-worth, so easily shattered by a careless word or pointed comment. We fear the day discrimination and disadvantage set in, knowing that no matter how beautiful someone may be on the inside, society has determined that invariably instantaneous judgements are made on what is first seen or heard on the outside. Edward regularly now attends 'his doctor', spending time alone with the specialist before Regina and I go in on our own to discuss the latest complicated issues arising at home. The child psychiatrist in reality looks after us all, and is an outstanding clinician and tactician, always prepared to listen, advise and encourage. There has been no need for medication such as haloperidol or pimozide, but we have tried a habit-reversal programme with awareness training, monitoring and developing a competing response. The sheer time involvement and incompatibility with reaching any sort of meaningful schedule precluded its value during the school term and, during holidays, freedom to play was the priority. The exasperation and frustration of the time it may take to complete often simple tasks, our ensuing lack of spontaneity in decision-making on outings or surprises and the baffled, flustered looks on Edward's face as we strive at times to conceal our impatience or anger are heart-breaking. Regina and I still cannot answer Edward as to what caused his Tourette's, whether it was anything we did, how it will progress and if there will be things he will not be able or allowed to do as he grows up. Personally, we have remained close in our marriage, despite the tension that may arise as we each cope in our own different ways. We have strengthened our resolve to confront any issues head-on in a determination to progress and not look back. Professionally, I am much more aware of how easy it is to feed superficially off the frenzy of the challenges and rewards of practicing in a frenetic emergency-medicine environment. I deliberately now step back and absorb myself in the pathos of sharing the experience of an unexpected, unwelcome, usually unwarranted sudden illness or injury with strangers, who allow us as emergency physicians into some of their most private and defining of life events. I do not think we truly realize how dramatic, demanding and debilitating many of the conditions we see and treat daily really are for the patient and family, and how small a component the emergency presentation is in the long continuum of each person's sickness. If I am now able to make their experience, understanding or acceptance of what happens to them in the emergency department and beyond that much better, to empower them from the start in their process of healing, I have achieved my greater goal. Edward is currently nine and he now reads to me, cuddled up on the sofa and we both ignore the grunts, coughs, lateral eye-gazing and arm-jerking, hoping and praying quietly to ourselves that he will be one of the 50% whose symptoms abate by the age of 20. Only time will tell. Meanwhile, our daughter Lucy, aged seven, has her first appointment with the same specialist. She has been coughing and throat-clearing repetitively now for over a year; please let this just be simple mimicry...