Thursday, November 30, 2006
Next: my assessment with the bosses. This went pleasingly well, and has left me with written evidence that I "ooze confidence". This will undoubtedly make me even more big headed than I already am; fortunately the nursing staff were on hand to remind me that that's not all I ooze.
Lastly, and perhaps most randomly, a girl I barely know has agreed, on principle to marry me. Matron is worried that the lady in question will end up on the shelf; as for me, I think she's just worried. Anyway, just as I was on my way out the door, Matron pipes up - "she'll marry you if you ask her". Nice. Acceptance of a proposal I didn't make, by a girl who doesn't really know me... I've decided to take it as a compliment.
The department was fairly quiet today, in case you were wondering.
Wednesday, November 29, 2006
Whatever your personal views are about Doctors with God complexes, surely it has to work both ways? If I can play God by not treating someone, what am I doing by treating someone. Didn't God create meningitis? Is a ruptured aorta too not God given? As far as I can see, you can't have it both ways; playing God as meaning making life-or-death decisions..?
So why do the papers never scream 'Doctors played God by saving my critically ill baby'? Not good news? Or do I just need to up my lithium dose?
Answers on a postcard, please
Friday, November 24, 2006
Ranting to follow...
Previously on 'The Knifeman'... I contemplated giving up the drink, and smoked a cigarette.
This weekend, I got royally plastered, and smoked a cigarette. This might be a worrying trend. My dismay was tempered, however, by a very dear friend of mine who gave me a t-shirt for my birthday; it celebrates a triple birthday - mine, hers and another friend of ours, all within a few days of one and other - with a collage of amusing pictures. Only after a while did I realise that one of these photos was of my genitals... still it's not every fella who can boast he owns a t shirt like that.
Today, I find myself marvelling at how quickly someone gets sick in front of you. I know that sounds obvious... ill people will go off if you just look at them - that's what they do. But sometimes people become more ill in retrospect as you begin to realise the enormity of how unwell they truly are.
The only analogy that makes sense was one I heard used by soldiers in Vietnam. They talked about VC snipers getting older after they had died. They would convince themselves that the 12 year old gunman couldn't be that young. Small for his age, sure. And youthful, 'cos of his race, sure. So that by the time they got back to camp, the 12 year old kid was 18, maybe even 20.
Anyway- I know what I mean.
Here's how it happened today...
---The young man is brought to us, welcomed into our warm embrace. The call came ahead of him. 'Known alcoholic, post EP fit'. Right now, he's not too unwell. We've all seen this before.
---He's post ictal now, sluggishly unco-operative as we slide needles into his veins, push and prod and probe him. 'Mother says he's done this a lot... always fits when he comes off the booze'... he's still not too bad. Obs are stable (-ish)... another withdrawal fitter...
---Then: actually, maybe he hit his head, as he went down... maybe. Mum says she thinks he's normally come round by now... obs still ok, sugar fine... but maybe his pupils don't look quite right... shit. Maybe he's bled. (Bleeding inside your skull is bad. It should be right up there on your list of places not to bleed from)
---Next: he wakes up, rambling, all over the place, hallucinating, gibbering. Struggling. Shit. Delirium tremens?
Lots of people pick up the habit of casually describing withdrawing, tremulous alcoholics as having the 'DTs'. They're usually wrong. I've seen a lot of alcoholics in withdrawal. I've seen a lot of tremens... but the DTs is a different kettle of fish altogether.
---Shit. He really is sick, isn't he. And his temperature's what? Shit... 39? Shit.
---Finally: as if adding insult to injury, his blood results come back. The final hurrah underlining quite how fully I had underestimated this guy's condition. Sodium 102; Potassium 2.2. Balls. Time to admit defeat, and call the fellas from Expensive Care. My 'routine' withdrawal fit evolved in front of me, into an unstable, head injured, encephalopathic metabolic nightmare. With the DTs. He won 24 cm of rigid plastic, and at least one night on a ventilator.
Sunday, November 19, 2006
The statistics tell us that binge drinking in young people is up - see Panorama on BBC1 this evening - and that bastion of liberal, rational thought, the Daily Mail was screaming about the number of people hospitalised by booze on a daily basis. The more I think about it, the more I'm forced to admit, they've got a point. Somewhere, deep in our culture, is the idea that a good night out ends up with us paralytic. I'm as, if not more, guilty than most. Medical school is, or certainly was in Shroom's day, almost a training ground for hard drinking. It is no surprise the medical profession fosters more drunks than most; we get our training in early.
For myself I consider this a great shame, because I like a nice drink with friends, but I now have serious doubts about my ability to drink responsibly, or whatever the current PC phrase is. So I am faced with the unappealing prospect of giving it up altogether... of course this could be yet more melodramatic over-reaction on my part; that would not be out of character, but if I find myself unable to know when enough is enough, what are my options? I nearly lost a very good friend to drink, have seen colleagues go to the wall with it and I've soured more than one relationship through it. Maybe enough really is enough. Time, Shroom, please? I'll let you know.
Since I'm feeling confessional, you may as well know I smoked a cigarette today. Just the one, mind, but I'm quite pissed off about it. I'd managed seven weeks. Ah, well; gotta keep on keeping on I guess. One in seven weeks, isn't too bad. Not that I'm counting...
To keep up the cheery mood, I continue to be distressed about the Government's ideas about how Medics should be trained. Several of my more eloquent colleagues have also held forth on this matter. I recommend this and this for a neat summation of the frustration suppurating within the profession.
Actually, since we no longer govern ourselves, we're, strictly speaking, not professionals anymore. Which is nice. My father, Pa Shroom, is an old school, retired, surgeon, and I regularly see him shake his head in amazement at plans put forth by the bunch of chimps currently governing this country. I am especially concerned for the future of surgery in this country. As training is shortened, and 'simple' jobs farmed out to Nurse Practitioners, there seems that surgery will go backwards. Pa Shroom fervently believed that Surgeons should be Physicians who "knew how to cut". This idea is still clung to by a few, and mostly laughed at by the real Magicians. Which is probably fair enough. But it bloody should be true. However, increasing knowledge base, and sub-specialisation has meant the end to generalists of all kinds. My big fear, though, is that if surgeons keep allowing themselves to be thought of as technicians, rather than well rounded medics, that is what they will become. And it's no great leap from there to abandoning medical training for them, because if they only cut, why would they need all that extra knowledge rattling around. I realise this is very far fetched, and I'm sure all surgeons out there are interested in the pre- and post op management of their patients medical problems, but I increasingly see an attitude amongst my knife wielding brethren of disinterest in anything that can't be cured with cold, hard steel. I even hear talk of surgical requests for medical consults on febrile post-op patients because "fever is a medical problem".
Friday, November 17, 2006
It was four a.m when the phone rang, summoning me from the pit, urgent, breathless. Then the waiting. Hurry up and wait. Finally he arrived.
Young, much younger than me. Whiter than the sheet he lay upon, face a mess of blood, one eye ruined and his nose smeared across his face. Car wreck; high speed; no output; downtime 90 minutes. All around me, the staff are working, anticipating what needs to be done, almost eager, as if by sheer force of will we can play God.
But I know it's hopeless. We can try all we want; nothing will work. There's no simple solution here. It's done. No-one disagrees, but I feel their disappointment. They wanted to win one. But we're not God. And God don't play dice; at least not to lose.
What a fucking waste.
Anyway; the night has been interestingly busy, until now. I have had some spectacularly slow Juniors on with me, and been more than a bit lazy myself. But the way seems clear now, which is why I'm on here.
I'm slightly grumpy and agitated because a case report I'm trying to write appears to have spiralled out of control, and developed a life of its own. I've lost track of the number of papers I've read in preparation, and appear to have found all sorts of facts and figures one furious, delirious night... which of course, I now can't find. Somewhere out there is the evidence I need. The Shroom will get published.
Having perused some of my medical colleagues efforts, I'm slightly disappointed I don't have anything more profound, or serious to add; makes me feel a bit of a fraud really. Especially as I feel like I have plenty to contribute. But actually I'm just like a backbench M.P. making plenty of noise, but all of it actually bollocks.
I'm still frustrated about what the government is doing to health care. They insist more money is being plumbed into it, but I don't see where it's all going. Emergency Medicine seems like a speciality under threat to me; if time is your most important marker (all hail the 4 hour target), then clinical care is at risk of being sidelined. Some days I don't feel like I do any medicine at all. I'm just a well qualified triage monkey. Cutting back junior docs hours and their responsibility delivers ill trained, under prepared junior doctors to a system that doesn't have time to teach them. Or worse, doesn't have room for them. It makes me sick. The body politic of the junior doctor should be amongst the most powerful in the land. And yet all we seem to do is get reamed by the Govt.
Thursday, November 16, 2006
Good things this week - picked up a fella with recurrent PEs who was in danger of drifting through the system with other diagnoses.
Meningococcaemic boy is improving
Bad things this week - sent a woman home a bit precipitously post treatment for ?anaphylaxis. However I know now that there can be significant withdrawal PV bleeding with adrenaline; who knows, I might even have exposed another pathology early. That might be a good thing, but for now - a bad thing.
There's more to come; have faith, hold the line etc
Sunday, November 12, 2006
The first thing I did on my shift today was to hold the hand of a dying man, so he wasn't alone when he breathed his last.
The last was to consign a two year old child to the ITU with meningococcal sepsis.
So I'm too tired. I'm going for a beer. I suggest you do the same.
A people who sacrifice liberty to gain security will likely lose both, and deserve neither.
I'm paraphrasing, but you get the idea.
Whilst I generally rail against the Left wing liberal hippy side of the Shroom, today seems like a good day to hug a loved one a remind them how you feel.
More ranting later, I promise.
Saturday, November 11, 2006
However, I did later have the honour to meet (and treat) a veteran of The Great War; at least, that's what she told me, but as she wasn't 106 years old, I'm thinking she meant WW2. Either way, it's sobering to meet people like that. For all the talk of a war on terror, and the occasional fear of some nutter blowing up a tube, I don't think my generation has any concept of what it must have been like in either world war.
To have a real fear that regime change might be forced upon you, rather than something your government implements on your behalf on some other poor bastards, hundreds of miles away. Part of me thinks this is responsible for general apathy / anti-war feeling. I myself struggle to come to terms with how I feel about the various armed incursions we are prosecuting right now. It seems to me that where we are interfering, the incumbents (e.g Saddam, The Taliban) were bad. At least according to our value system. And I guess that's always going to be true for a certain value of "bad" anyway.
But I'm not sure what we're doing is making anything better. I just don't think you can take one culture and completely subsume it with another... not without wiping out entire races / tribes / peoples. Which is called genocide. And that's bad. Isn't it? And because most people can't see what the Armed Forces are fighting for either, the deaths all start to seem meaningless. Which I don't think can be right. Fuck it, I don't know... the whole thing confuses me. But I'm worried that people will forget the significance of today. Whether war is right or wrong is not the soldier's fault, but the government that commands them. Either way, we should never forget those who went before us.
On a lighter note, we all scanned our bladders at work today. I lost.
Friday, November 10, 2006
I finally do have a day off tomorrow, in anticipation of my working the weekend. This will be a real day off, as opposed to my pseudo day off I grumbled so much about recently. Today I saw my first dislocated knee, which was less than pleasant for the owner of the knee, but I'm pleased to report we relocated it with no difficulty. On the bad day side of things, I had a disagreement with my boss about the management of a patient. This is never good, especially when you think you're right. Fortunately the resident magician took the case, and saved me from having to flat out disagree with the boss. I now have to find the evidence to back up my belligerence, or apologise. The Shroom is not quite as good as he should be at saying sorry; and Lord knows I've had enough opportunity.
Maybe you can't teach an old fungus new tricks?
The patient is doing well, by the way, all politics notwithstanding
Wednesday, November 08, 2006
Enough griping; I have work to do... it's my day off, y'know
This is my favourite time to be in hospital; it's quiet, and the semi darkness gives the dreary grubby hallways an almost magical feel to them. It's somehow satisfying to be going about my business while the rest of the world sleeps. You see odd things - strange little vignettes of life. Odd machines, that look as tho' they date from the War are wheeled around, emitting little flashes of green light, and beeping mournfully. There's never quite enough coffee.
Enough. I must rage against the croup with a 3 year old. Time to look God in the eye, and see who blinks first. While I'm gone, try the following to keep you amused:
Lastly, without wishing to sound like a corporate whore:
Those of you with a desire to experience the thrills of an African safari in glorious Tanzania, could do worse than to look up a good friend of mine. He's a redhead, but don't hold that against him.
Good night, and may your God go with you.
Tuesday, November 07, 2006
Well, for now, I AM the man in the white coat. I'll let you know what the source of the smell is, but I'm terrified it might be code brown...
Till next time
I stand on the verge of another night shift, filled with the trepidation that comes with knowing there's a good chance someone will try to vomit on you in the next 14 hours. Still, my mood continues to improve, and for no apparent reason. This is both pleasing (because I no longer feel depressed) and frustrating ( because I have no idea why I no longer feel depressed). Maybe my brief wrestle with the concept of my own mortality has done the trick; or not. Recently I have become worried about what to do when my parents die. This is wretchedly morbid, but I know the day will come, because it comes to us all sooner or later - unless, of course, one or both of Ma and Pa Shroom are bionic, and haven't told me. But I'm also concerned because I'm a grown adult, so apart from the emotional trauma, I should be able to get on with the actual living of my life. And yet somehow, I fear I won't be able to. As if somehow there absence will expose me as a fraudulent adult, blagging his way through being a grown up.
Bollocks to it. Too much of that sort of thinking is what started me off in the first place.
More from the night shift to come...
Wednesday, November 01, 2006
Today has found me at work on All Hallow's Eve, which has least spared me the mind numbingly tedious rites of passage that is delinquent trick or treating... not that I'm a killjoy, or anything, but I fully expect to return and find Shroom Manor defaced with eggs/faeces/sacrificed goats, etc. One of my colleagues has made the effort of dressing up, with a fake knife through his head, and dark green lipstick. I'm slightly worried that many of the patients won't realise the significance, and will just end up 'tut-tuting' about how dress code standards have fallen.
The night has, so far, passed relatively without incident. Things have picked up a bit just now with the arrival of a few lads who have decided to celebrate Tuesday with a lager fuelled punch up. What I always enjoy about these occasions is that they invariably think the ED is a suitable place to continue their pugilistic endeavours. Security for us is usually provided by men and women more suited to less physical pastimes, so it's agreat chance to practice diplomacy... if your that way inclined. At least no-one seems to have been badly hurt.
Our one serious case today was a youngish man having a heart attack. Despite having been rapidly and appropriately thrombolised in the field by the Paramedics, his symptoms were not improving in the ED. I could almost hear my sphincter tightening as ECG after ECG demonstrated persistant, extensive ST elevation. And he was slowly turning grey (regular listeners know how I feel about grey...) To spice things up yet further, his ailing heart began throwing increasingly frequent ectopics into the mix, and he developed haemoptysis. Fortunately, with a great moan of relief, his pain settled, and his ST segments began to normalise. Another case of masterful inactivity getting results
Lastly, for those of you still with me, my mental state seems to be on the up. I'm not sure if this is just because I'm at work... sad, but true, but being at work almost cheers me up. I guess this is because it represents a (relatively) controlled environment for me, with managable problems. Regardless of cause, I'll take it.
Ah well... back to the floor.