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A World War 2 Trilogy

By FRED NATH (Novelist and Neurosurgeon)

Fred's Blog


London, Riots and Politicians

Posted on 18 August, 2011 at 12:18 Comments comments (148)
Not blogged for a while, so thought I should catch up on the old recent events thing.
Since the riots last week we now have two opposite views on why they happened and how to deal with it.
The Labour view, expressed by Ed Minibrain, is that this country has too many rich people who only care about money so it’s changed social attitudes and they should be taxed more, so that poor people won’t want to steal, assault policemen and damage property.
Then there is the Conservative view from David Cameras-on, shock horror, sickening and we’ll stamp them out and leave them homeless and that’ll teach them. Sick society and I’m going to have meetings and (no doubt) mount a serious leaflet campaign  - that’ll teach them. Must be the parent’s fault and the teachers, of course.
Well, I’m afraid that the country being in the hands of people like this makes me cringe. It seems clear to me the rioters were mixed ages, races and perhaps class. One black man shot by police was always only an excuse for bored, uneducated youngsters, backed up by older people who saw an opportunity to steal. Why would it happen?
We have a police force who dare not move in on rioters, because if they do and someone gets hurt, they may find themselves in the dock facing unlawful killing charges. Having emasculated the police, is it not easy to see how riots developed? A line of police in riot gear stand and watch as looters empty shops, destroying people’s livelihoods. They wait for instructions which just don’t arrive. They should have charged the first rioters and I’m afraid they should have been hard on them. The riot would have fizzled out.
In the longer term, lefty Socialists with their wimpish policies need to consider the effects of their realised leniency. We had 13 years of Left-wing, namby-pamby nanny-state nonsense from the labour Party and it’s no use whining about it now. The riots, the financial disaster and empty Government coffers are a direct result of our voting. Maybe if they brought back National Service (for all, not just the unwashed youths in Council estates) values would change. The unemployed young people would at least be taught to read and write (11% of young people in inner London are illiterate) if not learn trades.
If you want to change social order it requires a huge re-think, but the riots seemed to me to be due to poor policing caused directly by political correctness tying the hands of the police and forcing them to take risks of injury to appease soft policing policies. Sadly, the politicians haveno answers, so nothing will change. In the end it will be up to individuals to bring about changes in our society because we’ve elected such a lot of twits.
The only bit of common sense is from Boris Johnson. He is the only one who has any sense if you ask me (bet you won’t though).

A shortage of Doctors!

Posted on 10 July, 2011 at 10:04 Comments comments (76)
So the Gov., bless their cotton socks, are telling people how there is a shortage of doctors (according to BBC News) and Trusts are spendinghuge amounts on locums to cover rotas, making patients safe again! Well I’ve got news for them. They are entirely responsible for any shortages. It’s a direct result of the immigration policy preventing Asian doctors from working in the UK. We had a good system before. Indian and Pakistani doctors came here,trained and went home. While they were here, they worked filling the junior posts and rotas worked because in the next tier there were smaller numbers. The foreign doctors went home and the UK graduates moved up. No rota problems because they were and still are, really keen to come here and train. But…
The Government introduced a system whereby they were not allowed to come. Suddenly, they said if an Asian doctor applies for a job any EU doctor takes preference in any job in the NHS. So, don’t blame me that the Eastern European doctor you see when you are admitted, can’t speak English. He doesn’t have to pass an English exam to work here – he’s here by right. Thank you TonyB. Liar. What a good job you’ve done. The NHS wasn’t safe in your hands mate! Don’t whine about shortages when successive Governments have caused the shortages. It’s
At the same time, they have let the EU dictate that junior doctors may not work more than 48hrs in a week. As a junior doctor, I worked a one in two rota (every week-day 9-5, and alternate nights on call in the hospital plus alternate week-ends) It worked out at about 128 hrs. per week. Well, we coped in those days because we were young. At that age you don’t need a lot of sleep and the exposure to the work was huge. You ended a job very tired but by Gum, you had experience. Now, they are not allowed to even attend tutorials outside the 48hrs. So when do they get training and teaching? Duh. They don’t.
On top of all this we’ve been forced to come alongside Europe with its inferior training and training has been shortened to six years.Do you really believe you can become a competent Neurosurgeon in six years? OK, it isn’t rocket science, but when these people are appointed to Consultant posts, don’t expect them to be like the old-fashioned Consultants – they won’t have the experience.
I feel a bit grim about it all. It’s all happening at a time when I’m close to needing hospitalisation myself (I’m 60!). I have serious worries that the people looking after me in my old age won’t know what they’re doing. Believe me – politics and the NHS don’t mix.

Access to Justice Just Got Worse!

Posted on 21 June, 2011 at 2:48 Comments comments (157)
So on today’s menu the starter is ‘Cuts’. No not best cuts of meat, but cuts in the infrastructure of our society. The Government in their wisdom now want to cut legal aid for all medical negligence cases. It will have far-reaching effects on an area of litigation where legal aid is most needed.
So you are treated by a doctor or surgeon and he does it wrong. You have suffered loss, maybe lost your job through disability caused directly by negligence. Well, you could argue that’s just tough, but if you want to claim for your losses and fight a big corporation like the NHS Litigation Authority it will cost you money. You will have to pay the solicitor and that is big money in today’s legal system. You have to pay for medical reports – and no one works for nothing. No Government support. Most people wouldn’t consider it, since the reason they want to launch a case is penury in the first place. Wealthy people might well be able to finance a case, but most can’t. To say that is unjust is an understatement. It interferes with access to justice for a part of the population who need support the most.
So what should you do if you are in that position?
Some solicitors will take a clear-cut case on a no win / no fee basis but it has to be strikingly obvious they will win.
It is possible to take out insurance to cover your losses if you are unsuccessful. Trouble is you will have to pay the premiums – Insurers don’t gamble after all.
There are solicitors out there who will give an initial free consultation to look at your case, look out for them.  
Another source of advice is AVMA (look it up on Google) they give advice and can help find a lawyer and they are not charlatans, nor do they cream huge sums of money from the Claimant.
Another tack is if you belong to a union. Your union may take on the case and finance it but let’s face it; if you don’t have a union you can’t have that help.
The fly in the ointment however, is that the patient’s perception of what went wrong is never objective. Some have an operation and get complications. That isn’t negligent usually. Negligence is when the doctor/surgeon does something which no other reasonable body of opinion would have supported. There are times when negligence has occurred but the case folds because one can’t demonstrate any measurable harm having been done. Exposure to risk (e.g. missing a fracture, or making the wrong diagnosis) isn’t a yardstick. It is possible to do something negligent and if it does no harm that can be proven in court, it results in the case fizzling out. Only a good lawyer can assess this. There are some very good lawyers out there too but like surgeons, they are not all good. Be careful whom you choose.
Don’t get me wrong, I’m not in favour of complaints. A lot of hospitals have big posters inviting patients to complain – not praise. Encouraging that leads to so much time wastage, it drives all working doctors insane in the end. I had to write a letter on one patient’s complaint where she was furious because, when she asked for coffee from the tea lady, she got a response which I can only say seemed appropriate – it was mid-afternoon at the time, after all. That complaint required a nurse manager to enquire, a consultant to write a letter and a further letter from the Chief Executive of the Trust.
Bottom line – if you think you’ve been dealt with in a negligent fashion, take a step back and assess whether you have losses. Then seek advice from a reputable lawyer or your union. Don’t bother to ask for legal aid – they’ve taken it away!

David Cameron Rides again!

Posted on 15 June, 2011 at 2:48 Comments comments (76)
Makes you want to laugh doesn’t it? There are the PM and his deputy in hospital, interviewing a patient. Cameras all around, a security team too. Heh Heh! In comes the Consultant who screams ‘I won’t have it! Get out. Why do you think we all have to dress like this! I won’t have it! Get out!’ Maybe he’s not in the running for a knighthood now.
Well, I’ll tell you what it was all about really.
Hospital doctors have been forced to abandon formal dress in suits for a short-sleeved, no tie approach to supposedly reduce the chance of infection on out clothes. When I asked the Bacteriologist at the Department of Health, who evolved the concept, what the evidence base was for using hand-alcohol wash every time you enter the ward, he replied that the reduction of infection mirrored the use of the alcohol hand-rub. He seemed to misunderstand that in an environment where infection was already falling the ‘evidence’ he cited is not evidence at all. No statistical support for the enormous expense, because it is so multi-factorial that it is impossible to study with any accuracy. Not that I’m against it, but our infection rates in Neurosurgery remain unchanged. We didn’t have much infection anyway. It brooked a lot of resentment in the Consultants. Maybe we’re an arrogant lot.
The dress code is even more interesting. So your jacket may harbour Staphylococci (a skin bacterium). Take your jacket off when you enter the ward. You might spread infection when you move from one bedside to another if you don’t. OK I take off my jacket. What next. Should I remove my trousers too? No, one nurse said, you can’t. OK, says I, maybe we should all take off all our clothes and do the ‘Naked Doctor’ thing. There is no evidence at all that removing more and more clothes makes a jot of difference to the incidence of infection. Hygiene is vital however. We’ve know this since the nineteenth century. All my professional life, I’ve used no-touch technique and hand washing between patients. I don’t need these amateurs to tell me to do it. The reason for the resentment and the outburst shown on TV is the pure frustration at the insulting insinuation that doctors know less about spread and control of infection that the twits who want to bring unnecessary changes to working practices. I agree with the irate Consultant basically – get out of my ward if you can’t behave the way we are forced to.
So in comes a camera team complete with security men. They are standing in a small ward without adopting the dress code forced on us all in the NHS. Is it surprising it caused a Consultant to erupt? He was venting his frustration at the fact that politicians and their teams seem to think they are so important they need not even consider rules which we mere mortals have to comply with. OK that’s a bit strong. It was probably because one of them had a firearm under his jacket and the other didn’t know how to behave in hospital. Mea culpa.
My final grin was that the last suited guy to leave the ward on camera, obviously has a baby at home. There were vomit stains on the back of his left shoulder – a sure sign both of fatherhood, and of dubious hygiene!

Fat, fat, and fat.

Posted on 3 May, 2011 at 3:45 Comments comments (73)
When you are born, the body fat is mainly ‘brown fat’. It is peculiar to babies. It produces massive amounts of heat and energy when the body burns it and is remarkably efficient in a chemical sense. That’s why a baby can stand exposure to low temperatures and remarkably, survive.
Sadly, life ain’t that good as you get older. You end up burning normal podgy yellow fat. It burns slower but produces less heat. It is stored in fat cells in all those embarrassing places we don’t want to show people. When you are young, you have a finite number of fat cells. They store a certain amount but can’t grow bigger than a specific amount. When they reach that size, they divide and you then have two fat cells. The number of cells it is possible to have in the end is therefore astronomical. Even if you lose your excess weight, the number of cells remains the same, so if you relax on the dietary side, you gain weight twice as fast.
The bottom line (excuse the pun), is: don’t put the weight on in the first place. If you already have, then you are going to have to be careful to control your intake for life. Sad but true. Maybe the best place to start is going to be to stick to three meals a day with nothing in between. Then reduce the portion size gradually so your stomach (not your waist) reduces in size. Appetite will slowly reduce. It has to be a change of life-style, not a yo-yo diet!
How can you maintain this sylph-like figure then, once you’ve got it? Well the answer is exercise. Not just to burn fat off, but to burn the calories you take in. Frequent small amounts of exercise will help raise your metabolic rate (the rate at which you burn calories to provide energy). Body temperature may also increase a bit. I suppose it’s simple, eat less and exercise regularly. Stick to low-fat food.
‘I’ve got a pot but it’s not fat’ he said. ‘There’s only an inch of fat there.’
The layer of fat on the outside of your abdomen is sadly no indication of how much of it you have. The bowel is suspended on a membrane containing blood vessels, called the ‘mesentery’. As you put on weight, the mesentery becomes stuffed with all-new, shiny fat cells. There is also a double layer of membrane over the top called the omentum. This is an apron of fat inside the abdomen. It gains fat and fat cells before you start to put on weight on the outside. You can have a situation where the ‘mammy-tammy’ (as the Scots call it), is no indication of the plumpness inside.
Some think Plastic surgery is the answer. Ever heard of ‘liposuction’? A long sharp-ended tube is inserted through a stab wound and strong suction applied as the tube is advanced and withdrawn. It mulches and sucks away the fat. Yes, it reduces the number of fat cells in that area. It works for small, localised deposits of fat but is no answer for obesity. It produces a localised delve in the fat and looks like a hole under the skin. Really only useful for say localised fat over the hips.
An alternative is an apronectomy. After losing a lot of weight, the skin can sag and overhang, particularly on the abdomen. That excess can be amputated but it leaves a scar which some may find unsightly. Unless you’ve already lost a lot of weight, it won’t help you at all.
Much better is: yes, you guessed it, EXERCISE. Walking briskly for 40 minutes every day reduces you chance of dying from cardiovascular events (like heart attacks). Drinking two glasses (not more) of red wine per day decreases, you chance of death from any cause by 20 % according to one study. If you have a heart condition you have to tailor your exercise to your heart – ask your doctor first.
Well, as Forrest Gump would say, that’s all I have to say about that!


Posted on 11 February, 2011 at 10:35 Comments comments (1)
My out-patient clinics seem to be transmuting into book-signings and judging by the people asking me medical stuff at my last book-signing, the converse is true as well.
One patient at the end of the consultation in my clinic, said, ‘On a different matter, Mr Nath, I read your book and thought it was very good.’
‘Thank you,’ I said.
‘Are you very religious yourself, then?’
‘No, I’m an atheist,’ I replied.
‘Oh I just wondered because the main character was so religious.’
‘But,’ I said, ‘that is a fictional character; it isn’t me.’
Which brings me to my point. I have a sneaking feeling all writers inject a little of themselves into their work and into their characters. My wife, Jane, read ‘The Cyclist’ and said she just knew I had written it because there was so much in it, which she knew I was capable of thinking or saying. Be that as it may, I can assure you all that Auguste Ran is not Fred Nath and I deny any similarities – well any big ones at any rate.
There is a thread in the book though, to which some readers seem oblivious and others puzzle over. I’ve worked in the Great Grumbling Machine of the NHS all my working life (a long time by anyone’s standards) and I’ve seen a lot of changes. Consultants used to have control over what they did and were trusted to have the integrity not only to provide the best possible treatment to their patients, they had the courage to treat the most deserving patients first without worrying too much about waiting lists etc.
Nowadays, there is a pernicious waiting-list culture, driven by targets made up by people who don’t understand the priorities which drive us. Patients in severe pain, patients whose lives could potentially be at risk and those for whom early intervention could prevent disability must come first. I recall having a conversation with a manager and explaining that the 17-year-old with the tumour had to be operated upon before the overdue waiting-list patient, because his life was at risk. The manager insisted the boy with the tumour could wait. Needless to say, I did what I thought was right and you don’t need to ponder too much upon what that was.
The relevance to my book is that the central character is one who has a nice tidy successful life until his world is taken over by a bullying hierarchy and he ceases to feel empowered or even trusted. This is quite like having one’s dedication and integrity called to question by people who are empowered by false ideals and a ‘Greater Power’ like Government.
Think about it. Should one just bend in the wind of change or should one stand firm and crack like a brittle old oak? I don’t know the answers to these things, but I reckon I’ll stick to what I know and hope it’s enough, like all us Consultants do.