Tuesday, June 19, 2007

South Coast Multiple Choice

Try to imagine you are a heavily pregnant teenager; now imagine you've been ahving contractions for a week.

The Obs and Gobs folks tell you it's early labour, and you're five cm dilated, then discharge you.

Q1: How best do you think your time can be spent:

A) Relaxing at home with your family?

B) On a fairground ride that propels you round at several G, and fires you upside down?

Q2: When you arrive at the ED in some pain, how long will it take for someone to ask, incredulously, 'You were where? Doing what?!?'

A) No time at all, they asked me as I was wheeled in

B) Why would they ask me that?

Part The Third

He got his op, and his private room, in which he had sex with his girlfriend, and on occasion smoked dope.

A senior nurse was allocated to him, and he would indicate his desires by pulling the crash bell, then screaming: "I want orange Lucozade, bitch!" Once they'd run to the shops to get it, he would spray it liberally over the walls and ceiling. "Clean that, bitch!"

The only saving grace, for me, was that I almost never came into contact with him, cloistered away, as I was, on the Burns Unit. For the 'offending' sister, it was not so easy, and the threats to her got steadily worse, until one day she by-passed management, and called the Police, and had him arrested.

In the van, on the way to the cells, he tore his dressing off, stripped his graft off, reasoning that if he needed more surgery, he'd be taken back by the Hospital. When that didn't work, he first set fire to his dressing, then tried to hang himself with it. This time, the Psychs felt he might have mental health issues. In the van on the way to the secure unit, he jumped out the back, while stopped at lights and escaped.

For the next few weeks, he, and his friends, would appear at the Hospital from time to time. If they caught sight of me, they would point with one hand, then draw a finger of the other hand across their throats, in a sort of throat-slitting gesture. Pure comic book.

They introduced locked doors on the wards after that, and started escorting Sister out the back door. I can't remember if he stopped coming, or if I left. I was only glad I didn't live locally.
I can laugh now, but for a while, I was genuinely scared.

I think that was when I lost faith in NHS management. Despite all the bullshit about zero tolerance, they never offered me any support; not for an instant. Nor was there any acknowledgement of the day to day misogynistic abuse the Nursing Staff had to endure.

Duty of Care must have some limits, eh?

Part the Second

This upset him. (Me touching him, not me imagining myself as Clint Eastwood), and he stood up, got right in my face and began screaming something along the lines of: "Who d'you think you are? I ain't afraid, You ain't no Big Man...", all the while coating my face in a generous layer of spittle.

After a few minutes of this, I'd had enough, and told him he could leave. This provoked death threats, and more abuse. Undeterred, I tried to evict him from the Hospital. For reasons still unclear to me, Hospital Management stepped in, and decided the best thing to do would be to let him stay, but in his own room. It was felt that he'd acted irrationally because of pain, or thirst, or something. A Psych opinion was sought, and they concurred. The whole thing was a fucking joke. I know now I should ahve just called the Police and had him thrown out, but even now it's difficult to do. My defence organisation backed him, remember...

The cynic in me thinks his dad was someone influential.

I was ordered to treat him, despite he and his friends repeatedly threatening my life - his friends, in black visored motorcycle helmets would wait for me outside the hospital, and gather around me as I left work. At least my time on the Burns Unit kept me mostly out of his way....

Saturday, June 16, 2007

I Wish That For Just One Time, You Could Stand Inside My Shoes, The You'd Know What A Drag It Is To See You...

Again, long time no jib...

Sorry. If any of my dwindling readership are still trying, I'm sorry.

I've been a little distracted of late. Shroom's fallow period has ended.

I have a new object of my affection. And it is mutual! I'm not a stalker. My current squeeze, my babyluv may feature here more later, but not for now. I don't want to jinx it, and I'm not sure I have the right to publish her the way I do myself; yet...

Anyway; I have a few local interest 'pieces' to blog about, but they will follow. They're mostly me grumping about what's happening at work. What follows, since we were talking of stalkers (sort of) is the tale of Shroom's only stalker - to date.

I know I've alluded to this recently, but don't think I've covered the details.

The whole sordid affair took place years ago, when I was a Plastics junior in a London hospital. At the time, I had rotated on to the Burns Unit, which meant I spent my days there, but shared the on call rota with the other SHOs covering Plastics and Burns. One Wednesday night, I took handover, and did my rounds, as usual. On the ward was a patient who had been waiting for surgery for a few days. I'm not sure why he'd been waiting but it was a bone of some contention to him, and he already had a reputation as a 'troublemaker' among the nursing staff.

The duty Reg and I stopped by to examine him, and see if we could get the op done overnight.

As I recall, the history was that this chap had been in a house that had been firebombed, and in trying to escape the inferno, he had gone out of a window, sustaining glass laceration to the dorsum (back) of one hand. On exam, it was obvious that his injury was substantial. There was significant skin loss, tendon and nerve damage. The op would require complex reconstruction and full thickness grafting - well beyond the capabilities of the Duty Reg and I, and as no consultant had expressed an interest in staying on to do it, we had no choice but to tell him he would have to wait another day.

He was not pleased; as we continued on our rounds, I was summoned urgently back to the ward. The fella was screaming and shouting at the nurses. When I went to find out why, he turned his attention to me. His primary complaint was that too much time had elapsed before the replacement of his dressing. He claimed that his hand had been left undressed for half an hour, and he was furious at the thought of it becoming infected.

When I pointed out that we had only left him five minutes before, he changed tack; the most vitriolic stream of abuse followed, the gist of which was that nurse were "bitches in skirts" who should be at his beck and call. He expected them to fetch and carry for him, and, I kid you not, "peel me grapes".

As this, almost laughable, rant continued, Sister attempted to re4place his dressing - made more difficult by the fact that he was gesticulating wildly. It must have been uncomfortable, because he flinched, mid-diatribe, and i saw his (good) fist curl up, and he went to swing at Sister. I did the only thing I could think of, which was to step in the way, and place my hand over his fist.

I suspect, in my mind, I was Clint Eastwood - as the Man with No Name.

This is part the first... I'm mid edit - apologies

Wednesday, June 06, 2007

Thomas Muir of Huntershill

Google it.

Maudlin again. Too many late nights and whiskey, I guess.

A couple of the blogs I like to read have gone invite only. I'm sorry if my side bar links lead you to a dead end. I'm slightly disappointed. I liked reading them - but folks have to do what they have to do, I guess.

I'm increasingly anxious about blogging my day to day work life here. Mostly because I'm less and less anonymous, and confidentiality is a huge part of what we do. Still, I'll try, for what it's worth.

Recently I've struggled with patients who have different ideas about what their best interests are than I do. Here's an example:

Let's suppose you elect to spend the afternoon drinking heavily. A few litres of your chosen spirit should do it, but feel free to wash it down with some beer chasers. I'm ok with that.

Next injure yourself; ideally, you should make the mechanism, the way in which you hurt yourself high risk - crash your car, fall off a bridge, you get the idea. BUT, and this is crucial, have little objective evidence of injury. A few grazes, here and there. Nothing spectacular, like being in more pieces than the good Lord intended.

On arrival at hospital, you should then slur your words, most of which should be Anglo-Saxon epithets anyway, and try to attack all hospital staff. This will involve removal of all the carefully applied devices protecting your cervical spine.

I am now left with the choice of allowing you to leave my department, with the knowledge that you might have significant occult injury, or restraining you, possibly at risk to my own health. I can guess that the way you are behaving is most likely an amplification of your own personality by your booze of choice... but it might just as well be your nascent extra-dural haematoma.

If the former, you'll wake up with a hangover, assuming you don't walk into traffic; if the latter, you won't wake up at all.

But, if I hold you down, and inject magic drugs into you, I have to be certain you don't have capacity, or I'm assaulting you.

I once treated a patient who was threatening to kill me; he has been my only stalker to date. I don't think I've blogged this before; I'll check - it might make good press. Anyway, I was reluctant to deal with a fella who was actively trying to stab me. My defence organisation informed me I had a duty of care unto him, right up until he actually did stab me.

I have to confess, I took my career into my own hands, and went against their advice, refusing to treat him. (It was neither a life, or limb threatening injury, for the record)

This country does not seem to have grasped the nettle of treating the (potentially) deranged, violent patient, who may simply be an arse, or may be acting like an arse because of their injury...

As for the example above... it might end like this:

You escape serious head injury, but turn out to have a broken neck. Despite assaulting every member of staff who comes near you, you avoid permanent paralysis. You wake up the next day with a hangover, and immediately discharge yourself from hospital, presumably reasoning that if the neck didn't give out during the fighting, it's good to go.

Sometimes, I wonder where my spirit went.

Friday, June 01, 2007

It's Hard To Be A Saint In The City

All things pass with time.

A few (proper) weeks in, and life gets a little easier. I'm starting to figure out how things get done, and feel my way about the Department. My referrals seem to be going down a little better. I still haven't figured out my bosses yet, not they me, but it will come - for better or worse.

The work is hard, much harder than my previous job, but no harder than I've worked before... just takes a little time to get back into the swing of things.

My house is still a mess (which is no great surprise), and I've startled my self by looking beneath the keys on my keyboard - not for the faint hearted...

One thing that always puzzles me when I start a new job is how far away from the enforced formality of years gone by we have swung. My default position is to be overly formal when I'm at work. I call my bosses "Sir", or "Dr. ...", especially in front of the patients. I also call the Sisters 'Sister'. No-one likes it. I'm not sure if it embarrasses them, or if they think I'm being cold, or what. However, that's how I was brought up, and I find it hard to change. I supposes it obviates the need for me to learn anyone's name too...

Maybe it makes me stand-offish, but I'm only trying to be polite. Familiarity breeds contempt? I'm not sure. Interestingly, if people call me 'Doctor', rather than 'Shroom', I too find it awkward. How's that for double standards?

Barn dance this weekend. Should be interesting.