Saturday, January 27, 2007

The Rag Man Draws Circles...

Another tough day.

I feel shit today. But that's my problem. More of that later.


I had a tough day, but it was bookended by two people having it far worse...

It began:
A young fella, fallen from a window. I'm not sure how. In the final analysis, does it really matter? We always ask 'how?' People rarely remeber. Why should they? It's the last thing on their minds. How he landed was more important, but we don't know that either. He was admitted overnight, so one of the other middle-grades worked him up. The unalterable truth, the only detail that mattered was the sensory level at T8. Below that, he could not feel a thing. Not a flicker of movement, no reflexes.


By the time I came on, at eight, he was still waiting for a CT scan. All the important folks had been contacted, and all offered the same grave opinion. I was to go down with him. Hold his hand. Sympathise. Console? Give him morphine, really, and try and keep him calm.

The Department was empty at eight. By nine, we were drowning, flooded by a tsunami of octogenarians. (This phrase was coined by one of the SHOs. Thanks, Baron)

We stayed in the Department, he went down without me.

The scans didn't bring better news.

Peg Fracture

Burst Fracture T6

Significant intrusion into the Spinal Canal

The MRI wasn't any more encouraging.

So the most significant part of my day was telling a family their son would never walk again.


The day ended with my relief not showing up. I was already tired, but someone needs to stay on. As one last offering, the Ambulance service spewed forth another wretched supplicant. A young man. Found collapsed. How? We always ask... no-one knows, but we always ask. How long? We always ask...

I had hoped to get the SHOs to run this case, but it was too complex. He was too unwell. My brain chose this moment to slip into neutral. Running on autopilot. Back up arrived promptly from the ITU. Every question we ask gets a worse reply.

---How long was he down for? We don't know

---How's he been since you found him? He arrested just after we got there; came back after four minutes, but he hasn't woken up

His blood pressure wouldn't hold up, his ABGs were rotten. At least his sugars and his temperature were normal. He rides down to the scanner, accompanied, but unaware. The scan comes back normal. This is as close to a good thing as you can get in a situation like this.

The second significant thing I did was tell another family their father was in a deep coma, and I didn't know why, or for how long.

We did manage to relocate someone's ankle in the meantime. I'll post the films after the weekend, as it's an excellent job, and the guys that did it deserve credit.

Why do I feel shit? I don't know, but I slept badly, and woke up with swollen eyes and a sore throat. Coming down with something? Probably. Would help me explain why I slipped into neutral last night. I hope the patients didn't notice.


View from the Trekant said...

Ouch! That is rough.

The only patient I've had to have the "You'll never walk again" coversation was a noncompliant smoking diabetic who ruptured an aortic plaque knocking off a spinal artery.

Rounding on this guy thereafter was so painful. He would ask each day, "Never? Never walk again? There's nothing else to be done?!"

Get some sleep KnifeMan - ya gonna need it. -Echo Doc

Bohemian Road Nurse... said...

That poor guy---I can't even imagine. And I hope you're not coming down with something. Try my BRN "cure": the couch, the clicker, and a quilt---and good ole Campbell's chicken noodle soup...

Cal said...


Sounds like you had a pretty tough shift...

When I read things like this, I feel really glad that I'm 'just' a medical student still.