Takin' Stock

As the New Year looms ever larger, I'm more prone to melancholia than usual. The usual - you've been there constant reader, don't pretend you haven't...

Missed opportunity, absent friends, previous New Years - good, and especially bad.

Without wishing to sound arrogant, which I'm afraid I surely shall, as I surely am, I have been dwelling on the only thing that keeps me going sometimes - treating patients. Sad to say I haven't got a lot else.

Anyway - success stories of the past. I hope I'm not repeating myself.

The first sticks in my mind, because it harks back to 'old school' medicine. That is to say with fuck all help from labs etc. I had just finished my pre-registration year, the first year out of med school, wherein you had to prove that yes, you'd passed exams, but would you kill patients when left alone. as long as the answer was 'no', or at least 'not many', you got fully registered.

Anyway; I had secured a 3 year surgical rotation, about which I was pretty smug, but deferred 6 months. So I was earning my keep doing a few locum jobs here and there. There was quite a ramp up in responsibility for some of these, as they were all short term, so no-one had time to hold your hand, or teach you. On this occasion I was providing cover at a rehab hospital. Small scale, elderly patients, none of whom was judged to need acute care, but none of whom could quite go home. Two rounds a day, a few jobs, and pretty much no calls at night.

Usually

So, I was roused from my sleep at ungodly o'clock in the a.m, as an ambulance had arrived. This was highly irregular. We weren't an acute facility, but the ambos decided some help better than none, and didn't think the patient would make it to big hospital, with it's bright shiny A&E dept. So, dropped into our laps was a fella, of, I think, late middle age, but he could have been older. His problem was extreme difficulty in breathing.

I remember looking at him, sat bolt upright, drenched in sweat, his skin a pale, waxy colour, tinged blue at the edges.

If you've been paying attention, you'll know what I think about these colours.

His face was vacant, lights on, nobody home, every ounce of his being dedicated to breathing. Arms locked to the sides of the trolley. Resps almost too high to count. JVP sky high, chest sounds drowned in wheezes and crackles.

Heart failure.

Now, the fun stuff. There was, I soon discovered, no working sphygmomanometer in the hospital. So, no blood pressure. Similarly, the pulse-ox readers were kaput. No labs or x-ray on site, and sending an arterial sample to big hospital wasn't an option because of the distance.

Great.

If truth be told, I can't remember what I gave him. Bronchodilators, diuretics and nitrates probably. A catheter to measure urine output, and so to judge renal function. My only measures of success were those I could see with my own eyes. The patients colour, his resps, his mental state, his jvp.

I sat with him all night, teasing him with a little of this, tickling him with a little of that. Slowly watching as he pinked up.

Should I have transferred him? Maybe, probably, I don't know. I didn't know any better. I thought I had to make him better. Out of my league, my depth? Maybe, probably.

But I managed. He managed.

Next...

I remember this, cos it's all a bit ER. Again, regular readers won't be surprised...

I was workin' in a DGH in the South East. I think as an A&E Reg, before my number. I was carrying the crash bleep, so I might have been in Anaesthetics, but anyway. The bleep squawked into life, the tinny voice of switch declaring adult cardiac arrest, in the car park.

In the car park?

Fair enough. Never one to shy away from attempted heroics, I up and ran. I remember it as pissing with rain, but it might just have been wet on the ground. It was dark, anyway.

The car park was just round the corner from the Ambo entrance, and the patient wasn't hard to find. She'd been visiting a relative on the ITU, and had just up and collapsed. I was first on scene, weak pulse, agonal resps.

For about 10 seconds, anyway.

Someone must have called the ambos, cos they pulled up. Which was nice, cos I had fuck all kit, and the car parks are not well stocked. Their AED clearly showed VF, but refused to shock the patient. There followed a brief argument between me and the ambos, first about how wrong their machine was (I was right), then about how best to scoop the patient and get her back to resus (they were right)

Back to shiny resus. A blur, resolving into shocking the patient...

And getting her back.

And sending her to the unit, to reside next to her relative.

And seeing her 5 days later, when she dropped by to say thank you...

Get in!

Well, folks, I'm working a special kindof graveyard tonight, and will be unstinting in my attempts to bore you with how shit it was. When midnight comes and goes, raise a glass and think of me and all the other poor bastards picking up the pieces.

Joy of the season to y'all.