Friday, December 15, 2006

It's my party...

Actually, it's not. It's the ED annual Christmas party, and I'm not sodding there. Yes, indeedy, I'm at work. Bastards. In fact, it's a grand old tradition that Shroom will be working on the day of any large, fun event that his department throws. So I shouldn't really be surprised. And my friends did phone up, from the party, while steaming drunk, to tell me how much fun they were having. Which was nice.

Meanwhile, back in the trenches. Tonight has been fairly slow. There have been a couple of high maintenance patients, making life difficult. The first was a nice fella, in his 70s, who lost control of his Mercedes (for legal reasons, you should know other cars are available), and stacked it into a field. Apparently he rolled it several times, and there was significant intrusion into all compartments. (it's fucked, basically) He had been in the department a while when I arrived. He had obvious external head and facial injuries, a compound (open) fracture of his left humerus, closed fracture of his right wrist, closed fracture of his right ankle and his bladder wasn't emptying. Oh, and he was on warfarin. (A rat poison, used by primates like us to thin the blood)

I caught up with him in the CT scanner.

1800 - take handover. Read through notes. Guddle about with various forms of contrast. Ponder the reasons why his catheter is not draining. Twiddle thumbs, while ionising radiation envelops patients whole body.
1830 - shudder with embarrassment when it becomes apparent that he still has his trousers on, with lots of metal rivets and coins therein, buggering up the CT scan.
1845 - breath sigh of relief as CT scan shows no serious injury to neck, chest or abdomen.
1847 - shudder yet more with embarrassment when CT reveals that the catheter is not in the bladder, but has been blown up in his urethra, causing some, not insignificant, trauma.

1900 - return to ED.
1915 - explain findings to patient, patient's son, orthopod, and general surgeon.
1930 - discuss catheter problem with urologist, who is in another hospital, 30 minutes away. And not leaving. We agree on a suprapubic catheter. I have never done one of these, but it seems easy enough.
1940 - orthopods want to take him to theatre, so agree to wait on SPC, on the grounds that it can be done while he's under.
1940 till about 2100 - attempt secondary survey, and clean up the fella's face, suturing as we go. Grumble about what passes for a fine suture set in the NHS these days.

So, for the first three hours of my shift, I was tied up with one patient. I did manage to fit in a quick hip reduction, while the orthopod was talking to him, but you get my drift. Now, the NHS, and indeed that bitch Hewitt, allow us 2 per cent breaches - i.e 2 percent of our patients can be in the department longer than four hours - and this guy would clearly be one. But this makes no allowance for the fact that while I am ensconced with this one guy, I am not out on the floor, seeing other patients. There is a domino like effect, and the breaches begin to mount up. I despise the four hour target, and the fact that it is trying to make time the most important factor in patient care, and especially the fact that it is trying to turn me into a triage monkey.

As I write this, the English cricket team is falling apart down under. Currently, nothing but a massive partnership between Freddie and KP will save us. I suggest you chase the blues away with your own print out, cut out and keep cricketer mask. Hilarious. No, honestly.

Lastly, I'm pleased to report an continued improvement in my mental state. When I began this, I felt depressed, although having read some of SHP's eloquent post's was forced to reconsider, and label myself miserable. However, I'm very nearly cheerful now. I'm sleeping better, and generally a lot less pathetic than two months ago. Hurrah. I think I started this purely to vent, in the expectation that it would fester in a little corner of the ether, and was genuinely surprised to discover other like-minded folks out there. Right now, I've got a lot of love for the community of blogonauts I've stumbled into. So it's probably time to cut back on my meds.

Which reminds me - drunken bishop. Great story, not such a great advert for the clergy. More later

1 comment:

Tisha! said...

Hi Doc, you've found a good way to release's so therapeutic!