Sunday, December 02, 2007

"Taxi For The Man In The Arseless Gown..."

On dignity and nappies.

A fellow blogger has had a few words to say about how our clients comport themselves. Manners are rarely a big priority. It's just like any job, obviously. With a few more drunks. And wankers.

I apologise if I've done this already. I have a habit of repeating myself...

One evening many moons ago, a young-ish man was rushed to us. His friends had brought him in, from the pub. He had spent his usual Saturday drinking and smoking. His friends figured he'd had at least 15 pints. Not so much, eh? Then, he'd come over 'a bit funny'. And been sick. Everywhere. Then passed out.

And wet himself.

And crapped himself.

His mates had piled him in the back of one of their vans, which was now truly soiled. They told us he'd had a heart attack and a stroke (or brain attack, if you prefer) in the past. This fella was little older than I, and had the co-morbidity of a septuagenarian. Despite all of this, he still lived the life of a teenager.

Anyway, he was presented to us; a blank canvas, albeit one soaked in fresh, warm effluent. We worked him in the usual way, en masse.

Open his airway, check his breathing. All clear. Check the pulses, blood pressure. All good. Get a line in, blood out - precious, precious, oh, yes, my precious... - fluid in.

Run the neuro. Quick GCS, check his pupils. Apart from being flat out, and stinking of... stuff, not much focal to find. Gut instinct? 15 pints, plus grey matter = coma.


Could it be something else? For sure. He's had one stroke, could this be another? The booze coma waiting game ensues.

IF: it's just booze, you can wait without a CT
BUT: if it's NOT just booze, you can't.
SO: you have to wait long enough for doubt to enter the equation, so you can buy a trip to the scanner from the Radiologist.

Wait too long, and you're a doofus. Jump too early, and he wakes up in time to negate the need for the scan, just in time to piss the radiologist off when he realises he's out of bed at two a.m for a scan that's not needed any more.

I decided to jump early with this guy. He seemed too flat for just booze. My team had shrunk by now, just me and a nurse; much more intimate. Me, my partner in crime and our patient. Our own special club. I was just bouncing the idea of the scan of the nurse, and opining that we'd need a catheter, when sleeping beauty stirred.

"No catheter" he slurred, offering us a share in his ethanolic miasma.

"No fucking catheter. Leave me my dignity."

My delight that he was waking, with now sign of stroke, mixed with joy that I had not yet called the Radiologist and sheer incredulity.

Your dignity? You spent the evening drinking heavily, before passing out, vomiting all over yourself and your friends, and their van before soiling yourself. And you're worried that my placing a urinary catheter, in private, with only an highly qualified nurse to witness the event, will impede your dignity?

My apologies.

Re-examination revealed a very drunk, slightly soiled man, with no apparent injury.
Another life saved.

As the fella's clothes were beyond wearing, we furnished him with an hospital gown - the kind that don't quite do up at the back - and pointed him to the nearest taxi rank.

I can't think why his friends didn't want to take him home


Anonymous said...

hahaha good post shroom. I can't help but wonder, what is it that you enjoy about emergency medicine??

Faith Walker said...

HAha- I love that.

I need some more intersting stories for the blog. Now i'm not in MAU anymore they aren't really forthcomin!

Baby Blue Pyjamas said...

The, emmmm clubs you mentioned. do they cater fo thoes in stlly pjs as well?

Faith Walker said...

Finally something funny happened to me today. I knew the patients would come through eventually! Blog post to follow later tonight (if i'm not too shit faced, or sleepy).