Kill Your Television

I am currently working on the renal service.  The renal service at my hospital is run by outside contractors.  We can't currently afford our own pet nephrologist, although I am told such an appointment is in the works.  The check is, I was told when I complained to the Chief of Medicine about certain aspects of our contractors' service, in the mail.  I assume all will be rectified shortly after we get electronic medical records, a couple more ultrasound machines, a new fully staffed outpatients clinic, retrofit the main acute care building, and install the long-awaited daquiri fountain in the lobby.  Until then, however, this is a kind of depressing job.  I have thought of a number of things to write to you about it, but discarded them all as participating in the "misery-loves-company" category - so instead, here's something I wrote during happier days when I was a medical student at a District General Hospital in Surrey in 2007.

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Today I discharged a patient recovering from tetanus.  This is, in the developed world, a vanishingly rare disease because everyone should have been immunized against it and received periodic boosters to maintain their immunity.  Our patient, however, had missed one somewhere and had been picked up by the paramedics with his arms uncontrollably spasming into gnarled claws and his intercostal muscles contracting so forcefully that they bulged out in between his ribs “like sausages.”  

            While a significant proportion of tetanus cases occur in the absence of any identifiable site of innoculation, most are associated with some kind of penetrating injury.  In our patient’s case, there were two recent events which seemed promising as possible points of contamination.

            1. He had recently commissioned a tattoo on his buttock, which read, in flowery cursive, “Your Name.”  (I have a photo, which was taken for clinical purposes, but after a rather short deliberation I decided against including it for reasons of patient confidentiality.)   He had several reasons for deciding to have this cryptic phrase permanently inscribed on his butt.  The first, which is probably obvious, was so that he could bet people in pubs that “I’ve got your middle name tattooed on me arse.”  He claimed it had already “paid for itself in pints.”  He clearly enjoys a more than usually jocular relationship with his ex-wife, since he joyfully related having made her one of his first marks – a practical joke presumably made doubly hilarious by the intense wave of relief she must have experienced when she discovered that he had not, after all, had her name tattooed on his arse.  The second, which is slightly more contingent, he explained as follows: several years ago, on his account, he was apprehended at a major London airport attempting to smuggle three quarters of a million pounds sterling worth of high-grade Afghan heroin into the UK – from where, and for whom, he was naturally reticent to say.  Since his release from the bastille, he  had found himself the target of the frequent and unwanted attention of the police, whom he accused (perhaps slightly overrating his significance as an international criminal mastermind) of “glory-hunting” in their obnoxious habit of stopping him whenever they got the chance.  He described an ecstatic (and not entirely unimaginable) pleasure in barking his new catch-phrase at the arresting officer as he was unceremoniously cuffed and, particularly, in the knowledge that in their subsequent report they would have to document both his defiant claim and its factual accuracy.

            2. As I alluded to above, he had what were somewhat patronizingly and euphemistically recorded in his A&E admission card, he had “mental health issues,” specifically a history of depression and self-harm.  He had grown, he told me, fed up with the stigma associated with the lines of healing cuts on his forearms, and had hit upon a novel plan: he shot staples into his thighs with a spring-loaded staple gun, which caught on his flannel boxers - like a sort of ghetto surplice - turning his self-harming ritual from a series of furtive outbursts into a continual regime of pain and abasement. 

            He was very proud of both these innovations, despite his ready admission that they were both plagiaristic.  In fact, they had a common source: he got both ideas from the popular American TV program “Jackass”. 

            I can’t help searching for morals in a story so frought with articulate significance, but I am at a loss.  Being a drug-mule doesn’t pay?  Keep your tetanus vaccine up to date? Only patronize scrupulously clean tattoo parlours? Autoclave your staple-gun?    Then I saw a bumper sticker bearing the title of this post, and I realized I need look no further.