Friday 21 October 2016

Rude awakenings for gas bag anaesthetists

Maurice Gueret

Published 07/09/2015 | 02:30

Beware what you say in the operating theatre
Beware what you say in the operating theatre
Dr Maurice Gueret

Smartphones are dangerous objects to bring to bowel exams, as one not-so gas lady found out.

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Two years ago, a Virginian man booked in for a colonoscopy, that medical examination of the lower bowel with flexible camera and all-important background lighting.

He told the lady anaesthetist that he had once fainted while having blood taken and that he was taking medication for a rash on his genitals. Before she packed him off to sleep, he pressed the record button on his smartphone so that he might better recall any instructions given to him after the test. What he played back later came as a bit of a shock. Once he was asleep, the anaesthetist said to her colleagues that after five minutes interviewing him in the pre-op room, she felt like punching him in the face to "man him up" a little bit. She also referred to him as a "retard and a 'big wimp".

She made a sarcastic comment about the school he attended and queried whether he might be gay, as it was once an all-girls school. She told a medical assistant to be careful not to touch his rash in case it was syphilis. Later, she wondered out loud if he might have tuberculosis of the penis.

The smartphone recordings came to court this summer, along with charges of defamation and verbal brutalisation. The Virginian received half-a-million dollars in damages, which included €50,000 for the syphilis comment and the same for the one about TB. The lady anaesthetist has gone to ground and has not been recorded for some time. I checked her name on the Irish medical register. She is not here. We operate zero tolerance for gas-bag anaesthetists.

Dr Cyril Daly RIP

The Sunday Independent carried a fitting obituary to north Dublin GP Dr Cyril Daly last month. Too many good ones go out of this world unheralded. Cyril was one who made a mark well beyond his surgery door. I knew him mainly as a writer in the Irish Medical Times. His weekly column always had something to say; conservative and challenging in equal measures. Those of us who would rarely agree with him would read him just the same. From time to time he would lapse into satirical fiction with wonderful tales of a made-up GP practising on the Skellig islands. He was Irish medicine's own Flann O'Brien. Where Cyril really left a mark was in the abolition of corporal punishment in schools. While my buddies and I were on the painful end of Holy Ghost canes and Spiritan straps in Rathmines, Dr Daly ran a one-man-campaign against cruelty in state classrooms and industrial schools. He lobbied politicians, collected signatures, participated in a memorable Late Late Show and regularly wrote in this newspaper about the effects of adult violence in childhood. In the late 1960s he removed his own boys from the local biffers of Raheny and drove them every day to a more humane and progressive non-denominational school in Ranelagh, on the far side of his city. No easy thing to do for a busy doctor or a conservative Catholic. But Cyril was his own man. Ireland's children left punishment beatings behind in 1982, the year Cyril Daly's mission succeeded. We owe this man a great debt. His family and his patients will miss him dearly.

Book of the year?

It's a bit early to announce my favourite book of the year, but Hidden City by Karl Whitney will take some beating. What's it about? Well the subtitle says it all - Adventures and Explorations in Dublin by Foot, Bike, Bus, Train and Tram in the Sewers and Underground Rivers, along the Edges and Behind the Hoardings. Penguin Ireland took a wise punt on Karl, a young Dublin philosopher who has sauntered around the capital observing things the rest of us are too busy to see. He notices that the best way to blend in with the Irish middle-class is to pretend that you are from nowhere at all. He goes to see where the Mountjoy prison-escape helicopter landed in 1973. He visits a 25-acre derelict site on a reclaimed rubbish tip in Irishtown that lunatics once paid €412m for. He visits holy wells, ponds and gaps in walls that will cure anything from gritty eyes to nasty headaches. Few parts of the capital's underbelly escape the author's gaze. He's been tagged as Dublin's best psycho-geographer since James Joyce, and I could swear Joyce was the city's best writer before Karl Whitney.


We have been working our way through a clinical examination in recent weeks and have found our way to the chest. We used the stethoscope to check your blood pressure last week and this week we are going to use it to listen to the heart. Doctors know this procedure as auscultation. You will know that the stethoscope has a plug for each ear, but closer examination of the piece that the doctor places on your chest reveals that it usually has two parts also. On one side is the bell-type part and on the other is the diaphragm, a surface like that of the drum. The doctor can listen with either. Low-pitched sounds are heard best with the bell, while high-pitched ones transmit better through the diaphragm. The two heart sounds that doctors know well are made by the closure of different valves. Most openings of healthy heart valves are actually inaudible to the doctor. Medical students are trained to spot little clues that might indicate faulty plumbing. Perhaps one sound is louder or softer than it should be. If two valves don't close together, a heart sound can be split. Sometimes there are extra third and fourth heart sounds, or murmurs, caused by blood flowing turbulently through a valve. Few students will get to pass out as doctors without being able to spot and diagnose common heart-valve problems. Next week, we'll get hold of a wooden spatula, have a little look at your throat, and get you to say "Aaah".

Dr Maurice Gueret is editor of the Irish Medical Directory

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