Tuesday, November 13, 2007

Weekends Are Fun. Right? (3)

I'm actually a bit written out on this now.

Sunday was proper shit. I left the department in a state, and it never recovered. Playing catch up was impossible. So, it was an unhappy return for me on Sunday night.

Once again, my evening was dominated by Resus. This evening's specials were the very breathless. I find it odd how cases seem to come in a run. I guess it's because we only remember the runs. When 3 breathless punters come in one after t'other, it sticks. 3 different cases doesn't seem such a big deal.

I got some lessons in assertiveness from the duty Surgical Reg. (Who else...) Its all about language. Our patient is an elderly chap, brought in when his wife found him collapsed, and unresponsive in bed. He had been fine earlier in the evening, but complained of a bit of pain in his hip, and retired to bed. The ambos had just confirmed his flat GCS and scooped and run.

At first, I was at a bit of a loss, but his BP of 50 systolic shed some light on his incapacitation. As did the presence of a firm, pulsatile, expansile abdominal mass. ED USS showed an aneurysmal aorta, with fluid in Rutherford Morrison's pouch.

Says I to the surgeon: Think this fella has a ruptured AAA...

Says the surgeon to me: He's got a AAA

Says I to he: That's what I said!

He to I: No; you said you thought he had.

Me: Ah, sorry. I was trying to be polite...

I guess I always say 'I think' before offering a diagnosis. But for me, 'I think' often means 'I'm sure'. Guess I should just say what I mean.

Anyway, an aneurysm it was, but not one amenable to surgery. Another night, another family whose hopes I've dashed.

All that's left is an attempt to find quiet dignity. We just about managed. It's hard to do in the ED. More of this to follow. Right now, I just wanna finish exorcise this weekend.

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