Rude Health: Waterworks Week
With black bread, bed-wetting doctors and blood in your uisce, says Maurice Gueret just about any diagnosis is possible
Operating theatres are very fine places of entertainment, but hidden dangers lurk everywhere for horizontal actors. They are called theatres, because that is what they once were. The patient was centre-stage, and there was tiered seating all around the cutting slab, for which medical students and ghoulish members of the public paid handsome fees to watch the action.
A doctor who works in one has alerted me to a problem with newfangled surgical drapes. Now, in my day, heavy, dark-green cloth sheets were used to cover up distracting parts of the patient or anaesthetist that the surgeon didn't wish to see. We never enquired as to where the surgical drapes went afterwards, but the assumption was that nurses in a hospital dungeon called the Central Sterile Services Department, subjected them to a jolly good boil wash and perhaps even a microwave oven. The advent of the disposable society put an end to much of this, and today's drapes are more usually paper-made with built-in adhesive strips to hold them in place. My informant tells me that these modern drapes are feather-light, but the glue is very strong. They have been known to cause significant skin damage if removed without adequate care. A theatre nurse was recently overheard telling a surgeon to be careful of "possible" as he was removing drapes from a patient's groin area. When asked to explain her unusual use of the word "possible", all became clear. It was recounted that as a student nurse, she had been taught by the nuns to give bed baths to male patients from below "up as far as possible" and from above "down as far as possible." The male member thus acquired the name of 'possible' among this cohort of student nurses. Ouch!
My knowledge of bed-wetting has always been pretty good. Lacking any domestic experience, I was lucky enough to spend six months of my senior house officer days at the Children's Hospital on Temple Street in a clinic devoted to what doctors call enuresis. Bed-wetting can be a distressing paediatric ailment, and is somewhat more common in boys. Most children overcome the problem before puberty, helped by a supportive environment and hindered by a punitive one. In all my time at the enuresis clinic, and since, I never came across a child (other than a toddler) who wet the bed deliberately. Until now. In recent evenings, I have been reading the memoirs of an Irish country GP who recounted his growing-up years during World War II. His secondary-school education was being plotted by his parents, and the son was not too enamoured with their idea of a boarding school. So he managed to scotch their plans by deliberately wetting his bed. In his own words: "I knew this would be a winner." He surmised that a "bed-wetting boarder would be a disgrace on the whole family". And he was right, and had his Indian-meal porridge at home each day before secondary school. Interesting that such a devious child could turn out to be a such a wonderful family doctor.
The doctor writes cogently about growing up between 1939 and 1945, the period known in Ireland as the 'Emergency'. He suggests that only an Irish government could have the sense of humour to understate the impact of war by describing it as something akin to having the electricity cut off. For once, Ireland had to fall back on its people and resources to produce its own food and fuel. White bread disappeared and a "marvellous laxative" called black bread appeared in kitchens the country over. He writes that the nation was never as regular as it was during the Emergency, and suggests that as Irish soldiers were entitled to more bread that the rest of the population, it was no wonder they were known as the Regular Army.
To serious matters. Every day, irishprisons.ie publishes a list of how many prisoners are in custody and where they are incarcerated. On any day, there are about 4,000 prisoners in the Republic, with perhaps a few hundred of them on temporary release. Bed-occupancy levels, well known in the hotels industry, are of the order of 90pc, which sounds very rosy, and makes it appear that there's plenty more room at the inn. But a hidden fact is that even our modern prisons are accommodating far more prison beds and prisoners than they were designed for. Doubling-up doesn't appear in the statistics. There are lessons to be learned from our neighbours here. Last month, England and Wales published their mortality statistics for 2014. There were 235 deaths in Her Majesty's prisons. A few have yet to be classified, but 120 were attributed to natural causes, two were murders, and the number of suicides was 82, the highest in many years. Over-crowding and staff cuts have been cited as major contributory factors. We could learn a penal lesson from that here.
I promised to cast an eye over waterworks today in our healthy quest to improve the nation's grasp of its own language. Important uireolaiocht (urology) symptoms to bring to the doctor include fuil san uisce (blood in the urine) and phian damanta in mo thaobh (terrible pain in my flank) either of which might indicate cloichin sa duan (stone in the kidney). Lamhnan is your bladder and the uireadar (ureter) brings urine down into it from the kidney. Not to be confused with uireadra (urethra) which is the final tube and orifice from which uisce (urine) emerges. Next week, we'll have a look at some male anatomy and symptoms that might involve the fhaireog phrostatach (prostate gland).
Dr Maurice Gueret is author of 'The Doctor's Case'
Sunday Indo Life Magazine