Saturday, December 08, 2007

Car-Nage

Another hot one...

Some of our 4pm til midnight shifts have slipped two hours, to become 6pm til 2 am shifts. Today's was just such a shift. Joyfully, I had booked a patient to come back for review at 4. I duly set off to make the commute; today, of all days, the traffic was shite. This coincided with my reaffirming my theory about drinking plenty of water. 3 litres a day? Balls. I am not convinced this makes me any healthier. It does make me piss like a racehorse. So, en route today, I dutifully drank a litre of God's finest tapwater. My timing is usually such that I arrive just in time to void, copiously.

Not today.

Constant reader, if you are not desirous of learning more than you really need about my bladder, look away now.

I made one pitstop about halfway, to stretch the Shroom's stumpy little legs, and add my contribution to the groundwater. The traffic jam 20 minutes away from work subjected me to the trials of patience peculiar to the bladder. I almost made it; but at the last, had to pull over. On this occasion, I could not find an appropriate bush to water, so was able to recycle my water bottle. And I filled it to the brim. A whole litre! Which went some way to explain why my back teeth had been floating. And yet 10 minutes later, once I got to work, I was able to void further. I didn't have a urometer to hand on this occasion, but reckon I passed another 500. So, one litre in, probably 2 out. I am the king of diuresis.

'Rehydration' my stretchy bladder.

Uriniferous miasma passed.

The department was once again heaving. My favourite boss asked me to weigh in early. I have so little life. I gladly accepted. Another shift in resus. Maybe I can get a little cot in the corner, and move in. It'll sure as hell cut down on my commute costs.

So - COPD decompensating in Bay one; serious trauma in 2 (donorcycle versus car); haemoptysis in 3. He ended up there because of a history of gastric carcinoma and abdominal aneurysm. He was pretty well, all things considered, which gave me time to goggle at the fact that bay 2 guy had done almost the same thin a year ago. He is surely getting the most out of his NHS tax dollar, but using up his nine lives, eh? I didn't quite keep up with what his injuries were this time, but our resus was for a time home to all the intensivists our little hospital has to offer.

The stability of haemoptysis man was further useful as it enabled a quick switch for status epilepticus girl. This wee lassie's story is confused by her non-diagnosis. We are all agreed that she has fits, but no-one knows why. The Neuro guys are pretty sure it ain't epilepsy; the Head shrinkers are pretty sure it ain't psychological; and the cardiac guys are wondering what it has to do with them. So far as I can tell, all tests are normal... which more or less adds up to 'psychological' seizures. Or pseudo-fits. The problem with this diagnosis is the stigma attached. It tends to be equated with 'faking it'. This patient certainly felt she wasn't being taken seriously by medical personnel, once they found out her non-epileptic diagnosis. And as far as I can tell, her fits were not epileptic, although I can see how they would appear to be to a lay person.

Does that change how I treat her? No, except possibly in that I'm less likely to give her benzos, or other anti-convulsants. Fits are fits; they still fuck up your day. Personally, I think they are psychological, but what do I know. I suspect this diagnosis will not ever be accepted by the family, or the patient. And as such, I'm not sure if she'll get better. Speaking to the family, it seemed to me that they considered the very idea offensive. I'm not sure this is fair. Like I say, fitting is fitting. Why should there be less stigma to a fit that has an 'organic' cause, as opposed to one that is 'psychological'? I guess this small question holds the nub of the stigma associated with all mental health issues.

Fuck it, what do I know?

A few more fits later, and a brief argument with the Magicians, and our lassie won a bed for the night. I hope her test results eventually tell her what she wants, and some treatment can be started.

She made way for a fracture dislocation of an ankle. Normally my bread and butter, I just could not relocate this one. I sheepishly had to turf to ortho. Macho Shroom? Not this day...

And with her passage out of the House of Fun, my nightly MI arrived. The MI that never was, fortunately. Brief panic, then transfer to CCU. Joy, and medicine of the highest quality. A few Paeds cases brought on the double bunking that seems de rigeur these days; in fact I even had the pleasure of treating a few in the corridor. To their eternal credit, the parents were understanding, and probably just glad to see a doctor. First world care, you see...

My shift ended with a smattering of trauma. Another donorcyclist, this one who worked in a brewery, and smelled like it, but seemed to have got away with facial injuries. The usual survey was complicated by the patients spectacularly awful dentition. He barely had a single tooth in his mouth, and could not tell me if this was how God intended him to be, or if the offending ivories might be nestling in his pulmonary nooks and crannies. At the same time, there was a great stacking of motor vehicles somewhere far to the north, disgorging copious numbers of inebriated youths, in various stages of injury. A major incident beckoned, but we were fortunate enough to be able to share the wealth with several sister hospitals. But this still left my colleague snowed under as the witching hour drew nigh.

A man of no doubt the highest moral fibre completed my night by overdosing on cocaine and heroin; an interesting combo, and another repeat offender, I noted with, sadly, little surprise.

My journey home was illuminated by the particularly piercing incandescent blues unique to ambulances. Erie when they aren't blaring the two tones... Over for the night?

Not even started, my friends

5 comments:

Chrysalis Angel said...

You have certainly been busy. Interesting about the seizures. I have never heard of psychological ones. I've seen seizures and just can't image what presents if it isn't physical.

Medblog Addict said...

I never thought I'd say it on a medblog, especially yours, but EWWWWW...TMI

DrShroom said...

I did warn you... sort of

Medblog Addict said...

Yes, you did, but you should have known that wouldn’t stop me from reading. LOL.

The conversation between you and 911Doc in your respective comment sections inspired me to write a post called “Guide to Reading the English Medblogs”. I haven’t finished it yet because my ass has been getting kicked at work, but I’m getting close. I’ll be counting on you to point out any errors I make. Be kind.

Medblog Addict said...

Dammit. See, I've already gotten it all wrong. I thought it was a "spot" of tea. Now I have to redo the whole post. Happy holidays to you too.