Thursday, January 18, 2007

The Summer Had Inhaled, And Held It's Breath Too Long

There was supposed to be a part the second, and indeed a part the third yesterday, but technical difficulties intervened.

---Anyway; what had been on my mind was continuity of care. This has had the habit of picking up controversy from time to time. Like fluff on your favourite shirt, if you will. Mostly because some people think patients used to get it, and that they don't anymore. Either way, Emergency Medicine has never been about long term continuity of care; and this fact holds much of its appeal to some people. Such as your resident fungus. So it is in that context that I say I don't much care for it. I enjoy avoiding ward rounds and clinics as much as possible.

---However, it is occasionally nice to see what has happened to memorable patients that pass through the Department. Now, obviously, I care deeply about the fate of every living thing I encounter, but some I am happy to trust to my erudite colleagues in the rest of the hospital, and others I try to follow up myself. Either to see them and wish them well, or to see what the blue blazes was actually wrong with them (which can, of course, allow the occasional smug(implied) 'I told you so' to be floated)... as in:
Shroom: Ah, hello Mr Surgical Reg
Reg: Shroom; aren't you an A&E weasel? Why have you darkened the doors of my surgical shrine? I mean, ward?
Shroom: Just checking on Mrs Abdo Pain from yesterday. You know, the one you said had a UTI (urinary tract infection)
Reg: Turned out she had an aneurysm. We opened her last night.
Shroom: Aneurysm. My goodness. Gosh. Didn't someone suggest that yesterday... I could have sworn they did...
Reg: **grunt**
Shroom: No. That's right. It was ME! I said 'I think it's an aneurysm' and you said 'Fuck off, is it'; or something... well, fancy that. Funny how things go, eh?
I am perhaps a little less direct, but, I suspect, often just as annoying.
Sometimes, I think it's better not to know. The fella I saw last week who'd come off his bike, with two smashed knees has been waiting days for transfer. At the time his partner asked if he might lose a leg. Having seen injuries like these before I had to admit it was possible, but, rather foolishly tried to downplay the idea. Privately, I felt sure he had a high chance of ending up with at least one amputation at some point, and the longer he waits for definitive surgery, the more debridement that goes on, the more likely this seems.
After what seems like months of driving rain, and flooding throughout the country, I was delighted to hear today that my local water company up London has finally lifted the hosepipe ban. The irony is almost killing me.
---A couple of funny old cases today. The weather was again dominated by gales and driving winds - gusting around the 90 -100 mph mark they tell me. This is more than enough to knock over pensioners on giro day. However our first was a fella who fell off a roof, trying to rescue a cat. Despite looking as if he had sustained multiple injuries, I couldn't find a damn thing wrong with him. We admitted him anyway, in case there was something lurking (I particularly distrust the retroperitoneum. I would advise you all, especially those in the legal profession, to make this top of your list of Body Cavities You Don't Trust. It surely tops mine.)
The second was an older lady, who despite looking well enough from end of bed, I couldn't find a damn thing right with her. She is one I'll follow up on...


Anonymous said...

ha! You have a lot of lists: colors to not be, places to not trust, noises to not want to hear...good stuff.

Arron said...

A lot of helpful data for myself!
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