Thursday, December 06, 2007

Choice Selection

Another ferocious day in the Department. I barely got out of resus; from start to finish, a cavalcade of the truly unwell. I am again frustrated by my inability to remember things that I think of as I'm driving that I'm convinced will make insightful, witty blog material.

Two things have managed to take hold.

First was an interview I heard on Radio 4. It was with an elderly lady who was a land girl during the war. These girls worked the land, doing the jobs left undone by the men so far away in the mud, blood and shit on the front. This lady had been a specialist in pest control, which essentially involved various inhumane ways of slaughtering rats and rabbits. She rationalised her job by telling herself that each beast slain meant one less piece of food that the Merchant Navy would have to bring.

She recounted a tale whereby the girls were taken to a farm and shown various fascinomas, including a caravan full of monkeys no less, and the corpse of a lion. This lion had done for the ex-rector of somewhere or other. Claspknife or something. It transpired that this rector had been helping the local fallen women, but had occasionally been helping them to fall a little further. He was subsequently defrocked and had taken to standing in a barrel on Blackpool Pier, protesting his innocence. He then moved to near Skegness, where a local man was exhibiting a lion. The ex-rector took to entering the lion's cage offering his soul to the Lord, proclaiming that if he were guilty, the lion would do the Lord's work.

Obviously, it ate him.

Justice? I found it morbidly entertaining.

Second was my thoughts on how different patients look when they're flat. I often form opinions about the patients I see while they're unconscious, only to have my ideas roundly disabused when they wake. This was particularly illustrated to me with one chap, brought by the Police. The story is all too familiar. A young fella, they're usually male, mostly young, is intercepted in his mission to drink too much then make a general nuisance of himself about town. Shortly after their arrest, they become strangely unresponsive. A quick trip to the hospital ensues, whereupon they are de-arrested, which usually brings on a rapid recovery and exit.

Cynic, thy name is Shroom.

So... this guy fulfilled all the above criteria, but I could not get him to wake. He looked like a rough-housing kindof guy. I saw him as a brawler, the kind of fella I might well cross the street to avoid. Anyway, I was still convinced he was putting it on. All his obs were normal, blood work the same. Catheterising, so often my go to procedure had barely raised a flicker. One last trick up my sleeve, before the onerous 3 a.m wake the Radiologist phone call...

This is one of my favourite tricks, but requires a serious voice. Standing over the patient, one opines, loudly, that the situation looks grim, and that a brain biopsy may be required. It helps if your assistant will gasp convincingly at this stage.

Next, equally loudly, ask for "The Large brain-needle". You, can, if you so wish, at this point, gently prod the patient's head with a bluntish sharp object. I use the end of a tendon hammer. The response was amazing. Rapid recovery. But what surprised me the most was how his features softened. He turned out to be the campest man this side of Liberace. He had great fun discovering, and removing his catheter.

Well, he didn't have fun, but we smiled a little when we heard the noise he made pulling it out.


Baby Blue Pyjamas said...

Sir I am humbled by your medical expertise. You've realy got to want to avoid the police to have a catheter put in. But to pull it out afterwoods..... ow. Ow on so many levels. I cringe to think of it. As i'm sure men everywhere do.

Faith Walker said...

What man would willingly put himself through the pain of pulling out his own catheter. Thats gonna smart!

RogerPf said...

The rector refered to is the infamous case of the "Rector of Stiffkey", Harold Davidson

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