I'm up early again. All too often I seem to see the wrong side of 4 a.m. I slept well enough, for a few hours; then, my all too traditional waking in a cold sweat. A bad dream? Not one I remember anyway. I vainly try to go back to sleep. Most days I'll know whether it's going to work within a few minutes.
Half an hour later, I'm up.
Pad round the house, aimlessly tidying a few things away. I spend a few moments gazing out the window. Funnily enough, no other bugger is up yet. All is quiet. I rather enjoy the peace, my horizons limited by the pool of light cast out by my lamp. Except I know it means I'm not sleeping.
I'm able to divert myself surfing for a while. I try to catch up on a bit of reading, but I'm never sure how much I take in in the wee small hours. 0430 and it's time for coffee. I dearly love all things caffeine; a taste for coffee has grown on me, over the years, ad I'm not sure it'll ever leave me. Which is good. I really love the coffee.
I'm just about ready. The cold, dark morning awaits me...
Cold showers are over-rated, but they sure as hell wake you up. It's still proper dark as I leave; full night, with only a few foolhardy souls for company. I allow myself a brief slice of boy racer as I power down the road, tipping the scales at 7,000 rpm, and glorying in the throaty roar of my Sports Penis Extension's engine, before dullShroom regains control. The realisation that there really are very few other bastards on the road slowly dawns as I encounter next to no traffic and arrive at work embarrassingly early. Even more so when I figure out I read the rota wrong, and have come in for 8, but don't start til 9.
The morning board round is preceded by the usual rounds of shooting the shit, most notably divulging that one of my SHOs is scheming to get a date with one of the radiographers. I think she's already dating someone, so this promises to be interesting; perhaps I can live vicariously through his exploits.
Proving once and for all that I am a sad old fart, with no life, I figure i might as well work, since I'm here. Number one punter is Polish, and we rapidly discover we have no language in common. Although interpreters are available, commercially, the trust seems reluctant to use them, preferring instead to rely on bilingual staff. Who are never around when you need 'em, and have their own jobs to do, anyway. Still, at least they're cheap. The patient smells of a three day bender, and is restless. He's 'MEWSing' at 5, which means his vitals are deranged. MEWS has replaced a sound knowledge of normal physiology, as far as I can tell. It is no longer necessary for one to look at a patient's obs, and decide if they are unwell or not. No, instead, someone distills the info into a handy MEWS score. Bah Humbug. Whatever his score, I think he looks pancreatitic; the bloods go off, and drugs and fluids go in. We wait.
Next a little old lady, with no real idea of why she is here. Dementia intercedes, making meaningful history taking defunct for the second patient in a row... My first, end of the bed guess is digitoxicity. A vain atempt to show off. I don't think it was right. Eventually we decide on a pleural effusion; the patient helps us along by having a small collection of fluid outwith her lung, and I ask the magicians for their assistance...
A young man offers us his racing heart with no good explanation. I take the easy route and blame his 10 day old son for upping his stress levels. Meanwhile, I'm trying to squeeze in a manipulation of a young girl's wrist, with one of my redoubtable SHOs. We have to do it in our MUA (manipulation under anaesthesia) room. It has recently been occupied by a patient with explosive diarrhoea. Despite a nuclear steam clean, the smell lingers. I'm amazed the patient can't smell it; this nasal insufficiency plays out in my favour a second time, as she briefly ends up with her face in my armpit; never the best of places to be, and not improved by a bout of strenuous tugging on a broken radius. Despite a good old fashioned Bier's block, she still finds uncomfortable, but backs down from her original offer to slap me afterward.
All the while an asthmatic COPD-er flirts with true respiratory embarrassment in resus. She is ably handled by another of our SHOs, but not before spectacularly vomiting. Excellent coverage; professional standard.
Polish guys's bloods lean towards the pancreas. I lean toward the surgeons, and they accept. I am briefly stunned.
We get something of a rush next. The specialist Cardiac nurse, or 'ThromboMan' as I like to call him, tries to monopolise Resus, smuggling in a fella with cardiac amyloid, among other things, and an elderly chap trying to see just how slow you can go. I deny him the chance to own resus by bringing in a young guy in status epilepticus. A tragic case, this young man's life ceased to be his own a few years ago when his blood sugar dropped low enough to provoke seizures, seizures that couldn't be stopped, and robbed his brain of oxygen long enough to leach most of its meaningful function. The patient is accompanied by a carer who assures us he does not have epilepsy, or seize 'normally'. Our efforts to stop these seizures depress his respirations long enough to force 24cm of semi-rigid plastic on him.
His trip to the Doughnut of Doom is uneventful - barely a hint of doomliness. The scan offers no new info, either. This passes to embarrassment when we look at his drug chart, and finally see the raft of anti-epileptic meds, and the letters from Neurologists in his casenotes, documenting his propensity to seizures.
At least we know why he fitted. He wakes, rejecting the tube, and another one is welcomed into the warm embrace of the magicians.
Lunch beckons, ad I leave Resus echoing to the cries of a lady who fell, catching the wheels of her zimmer on an escalator. Now, I know I'm a simple fungus, but I don't think those two particular advances in mobility technology were designed to go together. She has only slightly scalped herself, but sees everything we do as an outrage, loudly objecting to our attempts to examine her. She was still complaining 4 hours later, mostly about the fact that other patients were in the Department, using the toilet, and that she needed diazepam.
My post prandial slump encompassed writing a few sets of notes I had let slide. Resurgent after more coffee, I encountered another very young chest pain, again no evidence of cardiac pathology. My reassurances fall on partially deaf ears, but I know he's feeling better when I encounter him and his partner scarfing Burger King.
Another little old lady, another broken wrist. The redoubtable SHO and I spring into action. Our efforts are less successful this time, despite truly game counter traction from the patient herself; a second attempt is better, but produces the most shameful cast. I resolve to turn to Charnley more closely. My redoubtable colleague and I labour on, past our allotted hour.
And so, my shift that started an hour early draws to a close, 90 minutes late. It's dark again, and it's started raining. But I'm happy.
How fucked up is that?
Music Nazi recommends Wish You Were Here, by Pink Floyd. Do it; you kow you should.