sleeper hit

number girl
was playing
lit up
like a ghost
as the
summer ends
we turned 18 years old

i was born
and raised in Normal
40 minutes away
from their hometown
loaded as
a bowl
we watched
kids laugh
on sidewalks
and turn
18 years old

found an old
photograph, 6
months ago
where the lights
were the lights
of a small town
and the rain came
down like
a broken radio

諸行無常

"... the introspective slash emotional slash confessional mode predominated. For a time, it appeared as though this would continue to be the case prior to the advent of the modern cellular telephone, which heralded a new kind of technology that would eventually enable one to take a picture of oneself, embellish and augment those pictures, then instantly transmit those images to the cellular telephones of other individuals, simply with the press of a button."

"Don't listen to that stuff," Moon said. "It's anti-sapien propaganda." The holo-girl flickered as her projector circuits misfired, cutting out audio and skipping ahead. Every now and again this would interrupt her, resulting in a pause where she would look around the room, as if she had lost her train of thought, before resuming her script.

"... sense of self worth rapidly shifted from the internal to the external. This technological epoch allowed for near instantaneous dissemination of the image and saw most industries increasingly invested in appearance and 'brand' with the subject matter of most popular songs following suit."

Dita looked closely at the holo-girl. She was designed to look young. Her cheeks were healthy and plump, her lashes long. Her model was very well done. The folds of her skirt tousled themselves realistically with the movements of her torso, as if they had real weight. Dita had read books about how humans long ago loved objects with a kind of sacred intensity. How they admired the beauty of statues and paintings so much they installed them in their homes. Dita looked up at the holo-girl whose eyes scanned the room blindly as she talked. Emotionless, blank eyes that did not see, deaf ears that did not hear.

"... that the image holds power. What began as an act of sharing cherished moments and information with a few special people soon turned into an exercise in solipsism, in dominance and promotion and influence -- an insidious shift from, 'haha, hey look at this' to 'look at me.'"

Dita recalled reading a book written by a human about what the future might look like and was so struck by how wrong and how simplistic it was. Apparently there were many of these kinds of books. The humans it seemed spent an inordinate amount of time recording their predictions about the future. She marveled at how they used their intellect to justify absurd inventions and wild fantasies - and also at how bleak and terrible these imagined futures collectively were. It was as if the humans actively resisted anticipating anything other than moral and sociopolitical decline. That things could not keep getting better. That they could only get worse.

"... to perpetuate the duplicity and disingenuity of living as if unwatched -- to feign non-performance on a platform invented for the sole purpose of broadcasting broadcasting broadcasting..."

The holo-girl had apparently suffered some kind of critical error. She repeated the word over and over again, like a car stalling against a very steep hill. How long had she been talking for? Dita wondered. Would she snap out of it perhaps, or would this be her final loop. Maybe they had something in common after all. An obsolete design for an obsolete purpose. Death by repetition.

lacrimae rerum

love letters to ghosts

somewhere else, you are looking over my shoulder
and critiquing my syntax,
and later on, after the movie,
when your hand is on my hand,
i look surreptitiously over at you,
and realise how precious this is,
and resolve to memorise every second of it
so that i would have some totem, some
kind of touchstone, some kind of hope
of remembering you when you are gone,
and then you say something funny, like
'my eyes are up here, buster,'
and i respond with something clever,
and you giggle,
and the moment passes, and i
forget about the alternate reality
of a me who sits at a desk, imagining you
beside me, and me turning to face you,
telling you that somewhere else
is a me who isn't beside you
and how i am so glad
i'm not him

year of infinite promise and despair

life and death

"Every surgeon carries within himself a small cemetery, where from time to time he goes to pray."
- Rene Leriche


---

83 year old gentleman admitted with episode of syncope at home, reported feeling dizzy, clammy then lost consciousness for 10 minutes with rapid recovery and no further episodes of syncope. Reports suprapubic tenderness, sudden onset and severe intensity immediately preceding syncope. Bloods showed an AKI with a potassium of 6.0 with no T wave changes on ECG. Palpable bladder, tender and dull to percuss on examination. Seen by my consultant and diagnosed as vasovagal syncope and AKI secondary to acute urinary retention. Plan was to catheterise, treat the potassium and repeat the U&Es afterwards. At least that was the plan - before he started going vacant in the resus cubicle.

'We have a vacant episode over here!' One of the nurses yelled in my direction. Entering the cubicle, I find my man, who 5 minutes ago had been sat up, alert and talking, smiling and and asking questions, now staring off into space and acting like a robot that had its batteries taken out. Something was seriously wrong - and it was my job to find out what.

Stepping up to the plate, I tried to see if he would respond. "MR X... MR X! CAN YOU HEAR ME?" "WUH, WOUHHUHhuhh" he said. His eyes were still open, unfocused. His body splayed out on the trolley.

Another syncopal episode? Absence seizure? Acute stroke? "MR X???" No reply this time. I hold one of his flaccid arms in the air and then let go. It falls back onto the bed like a wet noodle. Same on the other side. Acute stroke causing syncope and affecting both sides?

All this time the nurse says to me, "He looks bad. I've seen patients like this before. Right before they're about to go off. Majorly."

The med reg happens to be passing by. He looks at me quizzically through a slit in the curtain and makes a palm upward motion with his hand as if to say, 'what's going on?' I bring him up to speed. We both stand there for maybe a minute, looking at his pupils, assessing his neurology, watching GCS drop and trying to work out why.

A passing A&E consultant glimpses our man and the complete lack of action being taken and, with a concerned expression, asks, 'What's going on with this man?' I tell him he's having a syncopal / vacant episode. "Has he had any atropine?" "No," I say. "Well, let's give him some atropine. Where's the defib machine?" The consultant's voice ramps up a notch in both volume and urgency, having decided he was now in charge of this acute scenario. He drags the defibrillator from a resus cubicle two beds down and applies the pads to my patient's chest. His heart rate reads 33, 34, 41, his systolic blood pressure which was previously 120 is now 60. We speed up his fluids and give the atropine and his heart rate goes up to 100. Within the next 3 minutes, his systolic BP goes up to 100 and the patient wakes up wondering what all the fuss is about. I struggle to find a viable vein to insert a second canulla for the insulin dextrose infusion and the sister in charge offers to have a look, which is the diplomatic way of saying, here, I'll do it. You're taking too long.

Life and death scenarios. That's what we're here to deal with. The whole point of medical training is being able to spot when something is going wrong, working out exactly what is going wrong and how severely wrong it is, and then being able to correct it. Contrary to popular belief, there aren't that many things that make you go from alive to dead in under five minutes. One of them is a blood pressure too low to provide oxygen to the brain, the heart and the kidneys.

Later on, I tried to debrief myself. If only, I thought, if only I had kept my head and gone through ABCDE I would have stumbled upon the answer in C. Instead I stood there, scratching my head. Not even thinking to ask for a set of observations.

The confounding factors were that I had looked at the observations 10 minutes ago - and not realised they may have changed drastically since. Secondly, we - and by we I mean the consultant - had provided a diagnosis. One that didn't fit with the current presentation. I didn't think to revisit the diagnosis again. And lastly and most worryingly, I hadn't recognised the acuity of the situation. I had in the back of my mind the knowledge that the last episode of syncope lasted for 10 minutes and ended with spontaneous recovery, and assumed that this would turn out the same.

I can't stop thinking about how, if that consultant hadn't stepped in, that man would have probably arrested - and died. From sat up, chatting and smiling - to not moving, not breathing, not living. Irreversibly, irrevocably, indefinitely dead. I had never been so close to that threshold before. That razor fine border between the two infinitely opposite states. An indiscernible event horizon, a turning point as invisible as the molecules that make up the universe, where on the one hand you have thought, emotion, relationships, identity, a past and a future, on the other, stark and absolute nothing. In ancient greek mythology, Atropos was the goddess who ended the life of mortals by cutting their thread with a pair of shears. The idea that human life was something as fragile and tenuous as a stretched out piece of thread. Liable to snap at any moment, without warning. Maybe they were trying to tell us something.

In an alternate reality, that patient would have arrested and we would have commenced CPR and shocked him, and maybe he would have regained circulation, but he would have also sustained cracked ribs and most likely a degree of hypoxic brain injury. If he hadn't regained circulation, his case would have gone to the coroner seeing as he had only been in hospital for five hours. And maybe I would spend the next five days, five years, fifty years asking myself - what if? What if I had done more? What if I could have done something to save him?

my friend tells me about how he nearly collided with a divider going 40mph driving home from his GP interview

yeah defo, im just thinking in an alternate timeline 
id either be dead or disabled 
already

feeling pill