This made me smile- the kind of smile that reoccurs suddenly because of it's ridiculusness...

P: a 79year old (but looks like he's 90), with an english-London accent, ex-graphic designer, patient at hospital with many MANY health issues.
Me: Not-yet-30 yrs old, doctor.

So the conversation went something like this..

Me: So what do you think of going home after dialysis on Friday?
P:Oh no, I couldn't possibly. It takes a lot out of me you know.. I'm not 18 any more.
Me: Neither am I!
P: Oh, but you look like you are 18 years old..
Me: I look young, I guess.
P: And once you reach 30, you're mutton anyway.
Me: !!!! (Walk away from the patient thinking.. I'm 3 years until I'm mutton! )

The following day..

P:So I hope you weren't offended when I said that comment about women being mutton.
Me: Oh no, not at all. (a white lie)
P:Because we live in a society where we're imaged obessed, we can't grow old gracefully anymore, everyone has to look younger and younger.
Once women hit 50 years old, their opinions don't matter. Noone wants to hear their opinions anymore, they become obsolete. There's no point marketing anything towards those old women.
Me: !!!!!

I was kinda offended at his first remark. The second, I thought, was just the ramblings of an old man who was developing some frontal brain changes.

So, consequences of actions:
(Very brief and un-PC: Apologies)
Fat lady with everything wrong with her asks a surgeon that she wants a lipoma(fancy word for non-life-threatening abnormal lump of fat) removed from her arm.
Surgeon tries to convince her the surgery is unnecessary.
She wants it out anyway.
Usually this is done under local anaesthetic (ie, numbing just the skin where the incision is to be made and the lump removed.)
The anaesthetist asks the surgeon if she should have some light sedation- something like valium to make you relax.
Surgeon says yeh ok.
Fat lady has a violent reaction to this sedation and ends up vomiting so much that she perforates small vessels in her stomach.
Ends up bleeding so much her heart cannot get enough blood to supply itself so she ends up having a heart attack.
The part of the heart effected by the heart attack happens to be where the valve is, so ends up having open heart surgery to fix the valve.
Surgery took a long time, and with her poor health to begin with ended up with kidney damage.
Kidneys didn't recover, and she consequently needs life long haemodialysis. (Filtering the toxins and crap in her blood by machine to take the place of her poor functioning kidneys.) Haemodialysis takes about 4-5 hours a session and depending on how bad the kidneys are, people might need haemodialysis daily. (4-5 hours per day is a long time considering transport to and from the hosptial which is only open business hours for dialysis..)
For this to happen she needs vein access which is difficult because of her size!
Multiple attempts throughout the following months ensue.
So i saw her for removal and re-fitting of a new permanent vascular access site for dialysis, as the old one had got infected.

So, all of this happened because of a decision to cut out a harmless lump of fat.
The patient's fault?
The surgeon's fault?
The anaesthetist's fault?
Fate??!

I've been noted to be in a pessimistic cloud recently.. more so than usual. I'm even out-cynic-ing weathered senior colleagues at work. Which is a big thing since they have gone through years of thankless patients, long hours at work with little financial gain, and the constant battle of the hospital hierarchy. I'm just a pleb- barely 18 months in clinical practice. I shouldn't be like this- rather fresh faced and bright eyed, with the only reward for my work, the knowledge that I've contributed to healing a fellow human being (Who may or may not be onwards towards the next St Mary MacKillop).

Why is this happening?
I've thought about this quite a lot recently.
I've blamed my IT background and the fact that I've had to deal with inter office politics, absurd dead lines, working late producing a work of art that no one reads (aka documentation). Perhaps that has made me cynical and once you are there's no going back? But surely it's pessimistic to think that once you've engaged in the black humours, there's no going back?

I've also thought it was because a few of my friends (and myself) have had unfortunate events occur to them. All (typical, it seems) relationship woes- All ending in heartbreak and tragedy.
It doesn't make me optimistic hearing stories of break up, cheating partners, general relationship uncertainties, unrequited love..

Then I've thought it might be the fact that I've got no idea what I want to be when I've grown up. Unlike all other degrees, graduating from medicine means not very much. It gives you the licence to work in a hospital as a junior. To be a specialist, whether it's GP, Psychiatry, Cardiology, Surgery, anaesthetics.. it all required at least 4 to 7 years of extra training including exams.
And I constantly think, the sooner I know what I want to do, the sooner I can start on this training and the sooner I can work my way to being someone.
But no, I have no ideas about what I want and hence in a bit of a limbo which may be contributing to my pessimism especially when most people around me know what they want to be.

And then I've thought that I'm just perverse and enjoy black humour in the first place, and find quite a lot of humour in the misfortunes- intentional or otherwise- of others. (And in hospital, lets face it, there's a lot of ammo for my sarcastic remarks, from various objects 'accidentally' placed in orifices they shouldn't be in, to drunken stupidity causing gross wastage of resources.)

I've recently finished reading The Count of Monte Cristo, and at the end of his intricate planning, and vengeance against those who did him wrong, the Count learns a lesson himself. That there is such a thing as a second chance; That there is reason to be optimistic and hopeful. People can pull you out of blind alleys if you let them. If only you just looked at the whole picture instead of the blinkered path you're used to seeing.

It's a hard manoeuvre, broadening your depth of perspective, but I don't want to be one of those angry, jaded doctors around work that eventually becomes an angry, jaded person full stop. So I guess despite my pessimism, I am a little(!) hopeful for the future.