Monday, December 18, 2006

Trading snakeoil for wolftickets

I had had a mind to write about cutting corners today. About how, in medical school you learn the formal way of doing everything, and then gradually learn to shave bits off, and streamline yourself...

But I've had a really rough day.

It started out well enough. Quiet department. Easy does it. The first case I saw was a young chap, attempted hanging. Not too bad really. No obvious neck injury, lungs seemed ok. Slowly, slowly crept his hypoxia. I've seen this before - negative pressure pulmonary oedema. Can develop very rapidly, and produce profound hypoxia. CPAP should see him right, but I hope they're as watchful on the ward... details to follow.

Next a collapsed adult. 68 years old, driving his car, fainted. Developed severe abdominal and back pain. Hypotensive and tachycardic on scene, his blood pressure had picked up a bit when he got to us, but his pulse was still batting along.

I know what you're all thinking.


Me too. We have no vascular surgeons here. We're supposed to assess them 'on the trolley' and transfer them out. I almost sent him on his way. But there was a history of trauma, and no history of aneurysm. He'd fallen, injured his ribs, on the left side. I could see the bruising. What if it's his spleen?

Split second decision.

I kept him.

He faded away right in front of me. Tried almost everything. Not that there's much to try. Too late to reverse his warfarin. Ultrasound confirmed his 7.5 cm aneurysm. He lasted about 45 minutes. I have been reminded that even though this fella's fate was inevitable, the wrong decision is still the wrong decision.

Some days, I really love my job


A Bohemian Road Nurse said...

It happens--even to the people who pretend to be "perfect". Hang in there. I see you changed your template-- I don't have the nerve.

Patient Anonymous said...

Hey there. I found you by finding me by er...well, you get it. Linkety link! Thanks for adding me *grin*

I won't even pretend to know what you go through as I can't imagine your job. Well, I can but since I don't work in it, well, I can't really comment on how it makes you feel as a doctor when someone dies.

But I can still think about it and be sensitive to it. And you know, it's actually good to see that as a doctor you're sensitive to it too. I mean, how would it be if patients were dying and you really no longer cared at all?

But still, how to find the balance, right? I second bohemian road nurse and for what it's worth, "chin up."

DrShroom said...

Thanks guys. I think sometimes there is no right; I still don't like it tho. Not what I signed up for.